Urology of Virginia Case Series

Not Applicable

Completed

Conditions: Prostate Cancer
Cancer of the PROSTATE
Prostatic Neoplasm

Interventions: Device: Ultrasound guided prostate exam using SOC ultrasound system
Device: mpMRI guided prostate examination using PI-RADS v2
Device: High-resolution micro-ultrasound guided prostate biopsy

Registration Number: NCT03035487

Lead Sponsor: Exact Imaging

Brief Summary: The investigational protocol describes a small case series designed to compare three imaging modalities for use in visualizing prostate cancer.

The three modalities to be tested are: transrectal micro-ultrasound , and conventional resolution transrectal ultrasound (LR-TRUS) (both as implemented on ExactVu, the multi-frequency novel micro-ultrasound system under investigation), and multi-parametric MRI (mpMRI).

These modalities will be used for guiding systematic (standard, random, extended sextant) plus image-guided targeted prostate biopsies among men with known cancer and an indication for prostate biopsy.

In the case of mpMRI, biopsy will be performed under micro-ultrasound guidance with the radiology report used for targeting.

Detailed Description: This trial will enroll nine men with an indication for a prostate biopsy.

The primary objective of the study is to provide guidance to clinicians who will be using the ExactVu system on the appearance of suspicious foci, and the difference between the appearance of these foci in LR-TRUS, mpMRI and transrectal micro-ultrasound images.

The study is being conducted based on the hypothesis that a series of same-subject comparisons will clearly demonstrate the differences in appearance between the modalities.

Procedures in the study are:

* obtain informed consent for the subject

* image the subject using mpMRI according to the PI-RADS v2 protocol, and obtain radiologist's report

* perform biopsy procedure using micro-ultrasound (this may be conducted in a separate subject visit)

* prepare biopsy specimens for pathology

* record all procedure details in a case report form, including pathology and mpMRI reports

The primary endpoint will be a standardized description using keywords of each biopsy sample region. These descriptions will be recorded during the blinded readings after the procedure to avoid added procedure time and will be used to compare appearance between the modalities.

Secondary endpoints are the pathological result of each biopsy sample (Gleason Score and percentage of cancer in sample), and risk score identified on imaging. Both of these values are per-sample, with 12 systematic samples per subject plus any additional targeted samples warranted by standard of care.

Recruitment & Eligibility

Status: COMPLETED

Sex: Male

Target Recruitment: 9

Inclusion Criteria

All men ≥ 40 years age and <80 years of age with a history of prostate cancer and an indication for a prostate biopsy will be offered inclusion in the study. Typical indications for biopsy include abnormal PSA (prostate specific antigen) and/or abnormal DRE (digital rectal exam) and/or history of prostate cancer.
PSA<50
Clinical stage < cT2c

Exclusion Criteria

Patients will be excluded from being included in the investigation if any of the following is true:

Men undergoing TRUS-guided prostate biopsy in the OR under anesthesia
Men with known prostate volume (from prior imaging) of > 60cc
Men with anorectal abnormalities preventing TRUS-guided prostate biopsy
Men who are unable to provide their own informed consent
Men who have contraindications to MRI or gadolinium chelate contrast

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Micro-ultrasound	Ultrasound guided prostate exam using SOC ultrasound system	Transrectal micro-ultrasound guided prostate biopsy, where images will be compared with images from standard of care modalities: * Low resolution transrectal ultrasound examination ("LR-TRUS") * Multi-parametric MRI ("mpMRI") examination performed according to the PI-RADS v2 protocol
Micro-ultrasound	mpMRI guided prostate examination using PI-RADS v2	Transrectal micro-ultrasound guided prostate biopsy, where images will be compared with images from standard of care modalities: * Low resolution transrectal ultrasound examination ("LR-TRUS") * Multi-parametric MRI ("mpMRI") examination performed according to the PI-RADS v2 protocol
Micro-ultrasound	High-resolution micro-ultrasound guided prostate biopsy	Transrectal micro-ultrasound guided prostate biopsy, where images will be compared with images from standard of care modalities: * Low resolution transrectal ultrasound examination ("LR-TRUS") * Multi-parametric MRI ("mpMRI") examination performed according to the PI-RADS v2 protocol

Primary Outcome Measures

Name	Time	Method
Keyword Description of Each Biopsy Sample	For each patient, keywords will be assigned within one week following the patient's procedure.	The primary endpoint will be a standardized description using keywords of each biopsy sample region. These descriptions will be recorded during the blinded readings after the procedure to avoid added procedure time and will be used to compare appearance between the modalities. Keywords will be derived from standard lexicons such as PI-RADS for MRI and PRI-MUS for Micro-Ultrasound.

Secondary Outcome Measures