A Phase III Multi-centre Open-label Randomized Controlled Trial of Multi-parametric Magnetic Resonance Imaging (MRI)-Targeted Biopsy Compared to Systematic Trans-rectal Ultrasound (TRUS) Guided Biopsy
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 450
- 试验地点
- 10
- 主要终点
- MRI-The proportion of men with clinically significant cancer (Gleason > 7)
研究概览
简要总结
The aim of this study is to assess the efficacy of MRI-targeted biopsy compared to standard of care systematic TRUS guided biopsy in the detection of clinically significant and clinically insignificant prostate cancer in men without prior biopsy. The implication of this trial is that MRI-targeted biopsy could replace systematic TRUS guided biopsy as the standard of care in the diagnosis of prostate cancer.
详细描述
The standard pathway for prostate cancer diagnosis is trans-rectal ultrasound guided (TRUS) biopsy of the prostate following an elevated PSA. TRUS guidance is performed primarily for anatomic guidance as the ultrasound poorly discriminates between cancerous and non-cancerous tissue. TRUS guided prostate biopsies are concentrated in areas of the peripheral zone, thought to harbor the majority of cancer.
An alternative pathway for prostate cancer diagnosis in men with elevated PSA is to perform multi-parametric magnetic resonance imaging (MPMRI) to localize cancer. This information is used to direct a subsequent biopsy, known as an MRI-targeted biopsy. MRI-targeted biopsy has been shown in preliminary studies to detect a similar or greater amount of clinically significant cancer than systematic TRUS guided biopsy and has several other potential advantages including: the ability to differentiate between clinically significant and insignificant cancer, reducing unnecessary biopsy and fewer numbers of biopsy cores, reducing biopsy-related side-effects.
A 'clinically insignificant cancer' is cancer that is unlikely to progress or to affect an individual's life expectancy and therefore does not warrant treatment. However when diagnosed with low grade cancer that is likely to be insignificant, a large proportion of subjects request treatment in case a more significant cancer is present. A challenge in this area is that subjects are typically not aware that their cancer is clinically insignificant, and often view the early diagnosis and aggressive treatment they have been subjected to as life-saving.
A prostate cancer detection procedure that differentiates clinically significant cancer from clinically insignificant cancer is therefore a major unmet need.
The potential implications of this trial include:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- Male
- 接受健康志愿者
- 否
入选标准
- •In order to be eligible, all inclusion criteria must be met:
- •Men at least 18 years of age referred with clinical suspicion of prostate cancer who have been advised to have a prostate biopsy;
- •≥5% chance of high-grade prostate cancer as calculated using individualized risk assessment of prostate cancer calculator, PCPTRC 2.0, found at http://deb.uthscsa.edu/URORiskCalc/Pages/calcs.jsp;
- •Serum PSA ≤ 20ng/ml within 3 months of randomization
- •Fit to undergo all procedures listed in protocol;
- •Able to provide written informed consent.
排除标准
- •Prior prostate biopsy
- •Prior treatment for prostate cancer
- •Contraindication to MRI (e.g. claustrophobia, pacemaker, estimated GFR ≤ 50mls/min)
- •Contraindication to prostate biopsy
- •Men in whom artifact would reduce the quality of the MRI, i.e. previous hip replacement surgery, metallic hip replacement or extensive pelvic orthopaedic metal work
- •Unfit to undergo any procedures listed in protocol.
研究组 & 干预措施
MRI
Men in Arm A will undergo a MRI followed by either a targeted biopsy of suspicious areas or will be followed for two years if there is no suspicious areas identified by MRI. The unbiopsied men will have a repeat MRI at 2 years.
干预措施: MRI (Procedure)
MRI
Men in Arm A will undergo a MRI followed by either a targeted biopsy of suspicious areas or will be followed for two years if there is no suspicious areas identified by MRI. The unbiopsied men will have a repeat MRI at 2 years.
干预措施: MRI Targeted Biopsy (Procedure)
Standard of Care
Men in Arm B will undergo a 12-core systematic TRUS guided biopsy. All men in the study will be followed for two years or until they have had radical treatment (whichever comes first).
干预措施: Standard of Care (Procedure)
结局指标
主要结局
MRI-The proportion of men with clinically significant cancer (Gleason > 7)
时间窗: 1 year
To determine whether the proportion of men with clinically significant cancer (Gleason \> 7) detected by MRI-targeted biopsy is no less than systematic TRUS guided biopsy.
次要结局
- Biopsy-The proportion of men with clinically significant cancer (Gleason ≥7)(1 year)
- Proportion of men in MRI arm who avoid biopsy.(1 year)
- Proportion of men in each arm with clinically insignificant cancer(1 year)
- Proportion of men in each arm with Gleason >4+3 detected.(1 year)
- Proportion of men in the MRI arm whom the PI-RADS score for suspicion of clinically significant cancer was 3, 4 or 5 but no clinically significant cancer was detected.(1 year)
- Proportion of men in each arm who go on to definitive local treatment (e.g. radical prostatectomy, radiotherapy, brachytherapy) or systemic treatment (e.g. hormone therapy, chemotherapy).(1 year)