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Prostate Embolization for Massive Benign Prostatic Hypertrophy (BPH)

Primary Purpose

Benign Prostatic Hypertrophy, Lower Urinary Tract Symptoms

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Embosphere microspheres
Sponsored by
Rhode Island Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Benign Prostatic Hypertrophy focused on measuring Prostate Artery Embolization (PAE), Benign Prostatic Hyperplasia (BPH), Lower Urinary Tract Symptoms (LUTS), PAE, BPH, LUTS, Prostate Artery Embolization, Embospheres

Eligibility Criteria

50 Years - undefined (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients selected for this study must meet all of the following criteria:

    • Age ≥ 50 years
    • Lower urinary tract symptoms secondary to BPH as defined by:
    • IPSS Symptom Index ≥ 12
    • Maximum Uroflow rate (Qmax) of ≤ 12cc per sec
    • Prostate of ≥ 90 gm as determined by MRI or transrectal ultrasound of the prostate (TRUS)

Exclusion Criteria:

  • Patients meeting any of the following criteria will be excluded from the study.

    • Age less than 50 years
    • Prostate cancer
    • Bladder cancer
    • Severe, life-threatening allergy to iodinated contrast
    • Bilateral internal iliac artery occlusion
    • Causes of obstruction other than BPH such as stricture disease
    • Neurogenic bladder or other causes of bladder atonia
    • Post void residual greater than 250 cc
    • Any contraindication to embolization, including
    • Patients intolerant to occlusion procedures
    • Vascular anatomy or blood flow that precludes catheter placement or embolic agent injection
    • Presence or likely onset of vasospasm
    • Presence or likely onset of hemorrhage
    • Presence of severe atheromatous disease
    • Presence of feeding arteries smaller than distal branches from which they emerge
    • Presence of collateral vessel pathways potentially endangering normal territories during embolization
    • History of any illness or surgery that might confound the results of the study, which produces symptoms that might be confused with those of the disease process under consideration, or which poses additional risk to the patient.
    • Previous prostate surgery, balloon dilatation, stent implantation, laser prostatectomy, hyperthermia, or any other invasive treatment to the prostate
    • Confirmed or suspected bladder cancer
    • Previous rectal surgery (other than hemorrhoidectomy) or history of rectal disease
    • Previous pelvic irradiation or radical pelvic surgery
    • Recent (within 3 months) cystolithiasis
    • History or presence of urethral strictures, bladder neck contracture, potentially confounding bladder pathology, or (within 5 years) prostatitis
    • Active urinary tract infection
    • Concomitant medications:

      (i) Use of anti histaminics, anti convulsants, and antispasmodics within 1 week of treatment unless there is documented evidence that the patient has been on the same drug dose for at least 6 months with a stable voiding pattern (the drug dose should not be altered or discontinued for entrance into or throughout the study) (ii) Use of alpha blockers, anti-cholinergics, androgens, and gonadotropins-releasing hormonal analogs within 2 months of treatment (iii) Use of 5 alpha reductase inhibitors within 6 months of treatment

    • Compromised renal function (i.e. serum creatinine level greater than 1.8 mg/dl, or upper-tract disease)

Sites / Locations

  • Rhode Island Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Embosphere microspheres

Arm Description

Embospheres are calibrated microspheres which will be percutaneously delivered intra-arterially via a microcatheter under fluoroscopic guidance to occlude the prostatic arteries.

Outcomes

Primary Outcome Measures

Clinical Improvement in Lower Urinary Tract Symptoms (LUTS)
Questionnaire

Secondary Outcome Measures

Number of participants with treatment-related adverse events
Safety and Tolerability as assess by CTCAE 4.0
Change in peak urinary flow (Qmax)
Urodynamics
Change in prostate size
Imaging (MRI or Transrectal ultrasound)
Change in serum PSA from baseline
Blood test
Erectile and sexual function questionnaire
Questionnaire
Pain
Pain Questionnaire
Post void residual bladder volume (PVR)
Imaging (ultrasound)

Full Information

First Posted
January 17, 2016
Last Updated
July 2, 2021
Sponsor
Rhode Island Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02676544
Brief Title
Prostate Embolization for Massive Benign Prostatic Hypertrophy (BPH)
Official Title
Prostate Embolization for Massive Benign Prostatic Hypertrophy (BPH)
Study Type
Interventional

2. Study Status

Record Verification Date
July 2021
Overall Recruitment Status
Terminated
Why Stopped
Device approved for this use
Study Start Date
December 2015 (undefined)
Primary Completion Date
June 30, 2021 (Actual)
Study Completion Date
June 30, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Rhode Island Hospital

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a prospective, open label single center feasibility study to demonstrate basic safety and effectiveness of prostate artery embolization for the treatment of symptomatic benign prostatic Hyperplasia (BPH) in a small series of patients with large (≥90 grams) glands.
Detailed Description
This is a prospective, open labeled, non-randomized, single center feasibility study to evaluate the technical and clinical success of prostatic artery embolization utilizing Embosphere microspheres. At initial consultation patients will be screened to assess the severity of lower urinary tract symptoms (LUTS) related to BPH utilizing the international prostate symptom score (IPSS). After determining eligibility, pre-procedure baseline evaluation will be completed. A baseline prostate ultrasound (TRUS) or MRI will be required to assess prostate mass, and baseline prostate-specific antigen will be measured to help exclude carcinoma and also to follow response to therapy. Patients with suspected malignancy of the prostate will not be enrolled without a negative biopsy finding. Pre- procedure urodynamic studies will be required to assess additional objective measurements and to exclude other causes of LUTS. Cystoscopy will be performed prior to any intervention to help exclude bladder malignancy. If the patient qualifies by the level of symptoms (IPSS score ≥12), prostate size ≥ 90 grams and max urinary flow rate (Qmax) ≤ 12, the patient will be asked to consider enrolling in the study. A study investigator will review the proposed treatment and baseline/follow-up schedule. If the patient agrees to participate in the study, baseline data will be collected on a case report form and an appointment will be made for prostate artery embolization in the interventional radiology department.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Benign Prostatic Hypertrophy, Lower Urinary Tract Symptoms
Keywords
Prostate Artery Embolization (PAE), Benign Prostatic Hyperplasia (BPH), Lower Urinary Tract Symptoms (LUTS), PAE, BPH, LUTS, Prostate Artery Embolization, Embospheres

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
9 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Embosphere microspheres
Arm Type
Experimental
Arm Description
Embospheres are calibrated microspheres which will be percutaneously delivered intra-arterially via a microcatheter under fluoroscopic guidance to occlude the prostatic arteries.
Intervention Type
Device
Intervention Name(s)
Embosphere microspheres
Intervention Description
This is a clinical trial assessing the feasibly and safety of prostate artery embolization (PAE) for benign prostatic hypertrophy (BPH) resulting in severe lower urinary tract symptoms (LUTS) in patients with gland size ≥90 grams who are TURP ineligible or non-operative candidates with Embosphere microspheres.
Primary Outcome Measure Information:
Title
Clinical Improvement in Lower Urinary Tract Symptoms (LUTS)
Description
Questionnaire
Time Frame
24 months
Secondary Outcome Measure Information:
Title
Number of participants with treatment-related adverse events
Description
Safety and Tolerability as assess by CTCAE 4.0
Time Frame
12 months
Title
Change in peak urinary flow (Qmax)
Description
Urodynamics
Time Frame
24 months
Title
Change in prostate size
Description
Imaging (MRI or Transrectal ultrasound)
Time Frame
24 months
Title
Change in serum PSA from baseline
Description
Blood test
Time Frame
24 months
Title
Erectile and sexual function questionnaire
Description
Questionnaire
Time Frame
24 months
Title
Pain
Description
Pain Questionnaire
Time Frame
12 months
Title
Post void residual bladder volume (PVR)
Description
Imaging (ultrasound)
Time Frame
24 months
Other Pre-specified Outcome Measures:
Title
Procedural time in minutes
Description
Total PAE time for informational purposes
Time Frame
1 day
Title
Total fluoroscopy time in minutes
Description
Total procedural fluoroscopy time in minutes for informational purposes
Time Frame
1 day
Title
Size of catheter used for embolization
Description
Microcatheter size for informational purposes
Time Frame
1 day
Title
Volume of contrast used in mL
Description
For informational purposes
Time Frame
1 day
Title
Length of hospital stay
Description
Expected to be less than 1 day
Time Frame
1 day
Title
Volume of embolic material used in mL
Description
Total volume per prostatic artery utilized to achieve stasis
Time Frame
1 day
Title
Total fluoroscopy dose mGy
Description
Measured in mGy for informational purposes
Time Frame
1 day

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients selected for this study must meet all of the following criteria: Age ≥ 50 years Lower urinary tract symptoms secondary to BPH as defined by: IPSS Symptom Index ≥ 12 Maximum Uroflow rate (Qmax) of ≤ 12cc per sec Prostate of ≥ 90 gm as determined by MRI or transrectal ultrasound of the prostate (TRUS) Exclusion Criteria: Patients meeting any of the following criteria will be excluded from the study. Age less than 50 years Prostate cancer Bladder cancer Severe, life-threatening allergy to iodinated contrast Bilateral internal iliac artery occlusion Causes of obstruction other than BPH such as stricture disease Neurogenic bladder or other causes of bladder atonia Post void residual greater than 250 cc Any contraindication to embolization, including Patients intolerant to occlusion procedures Vascular anatomy or blood flow that precludes catheter placement or embolic agent injection Presence or likely onset of vasospasm Presence or likely onset of hemorrhage Presence of severe atheromatous disease Presence of feeding arteries smaller than distal branches from which they emerge Presence of collateral vessel pathways potentially endangering normal territories during embolization History of any illness or surgery that might confound the results of the study, which produces symptoms that might be confused with those of the disease process under consideration, or which poses additional risk to the patient. Previous prostate surgery, balloon dilatation, stent implantation, laser prostatectomy, hyperthermia, or any other invasive treatment to the prostate Confirmed or suspected bladder cancer Previous rectal surgery (other than hemorrhoidectomy) or history of rectal disease Previous pelvic irradiation or radical pelvic surgery Recent (within 3 months) cystolithiasis History or presence of urethral strictures, bladder neck contracture, potentially confounding bladder pathology, or (within 5 years) prostatitis Active urinary tract infection Concomitant medications: (i) Use of anti histaminics, anti convulsants, and antispasmodics within 1 week of treatment unless there is documented evidence that the patient has been on the same drug dose for at least 6 months with a stable voiding pattern (the drug dose should not be altered or discontinued for entrance into or throughout the study) (ii) Use of alpha blockers, anti-cholinergics, androgens, and gonadotropins-releasing hormonal analogs within 2 months of treatment (iii) Use of 5 alpha reductase inhibitors within 6 months of treatment Compromised renal function (i.e. serum creatinine level greater than 1.8 mg/dl, or upper-tract disease)
Facility Information:
Facility Name
Rhode Island Hospital
City
Providence
State/Province
Rhode Island
ZIP/Postal Code
02903
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Prostate Embolization for Massive Benign Prostatic Hypertrophy (BPH)

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