PRostate Evaluation for Clinically Important Disease: Sampling Using Image-guidance Or Not?

NCT ID: NCT02380027

Last Updated: 2018-05-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-01-31

Study Completion Date

2017-12-31

Brief Summary

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This evaluates the detection rates of prostate cancer by MRI-targeted prostate biopsy compared to standard 12-core trans-rectal ultrasound guided (TRUS) prostate biopsy. Each participant will be randomly allocated to one of the biopsy tests.

We hypothesise that MRI-targeted biopsy will detect no fewer clinically significant cancers than TRUS biopsy but will detect fewer clinically insignificant prostate cancers than TRUS biopsy.

Detailed Description

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The classical pathway for the diagnosis of prostate cancer is trans-rectal ultrasound guided (TRUS) biopsy of the prostate following a raised PSA. This is currently the mainstay for prostate cancer diagnosis in the majority of centres. It has many advantages and can be performed routinely under local anaesthetic in an outpatient setting. However it does have some limitations, including the over-diagnosis of insignificant cancer and the under-diagnosis of significant cancer.

An alternative pathway for the diagnosis of prostate cancer in men with raised prostate specific antigen (PSA) is to perform a multi-parametric MRI to localize cancer and to use this information to influence conduct of a subsequent biopsy, known as an MRI-targeted biopsy. MRI-targeted biopsy has been shown in preliminary studies to detect a similar amount of clinically significant cancer to TRUS-biopsy but may have several advantages, for example in reducing the number of men who require biopsy.

This randomized controlled trial aims to assess the detection rate of clinically significant and clinically insignificant cancer of MRI-targeted biopsy compared to standard 12-core TRUS biopsy in men referred with clinical suspicion of prostate cancer who have had no prior prostate biopsy.

A 'clinically insignificant cancer' is cancer which is unlikely to progress or affect a man's life expectancy and therefore does not warrant treatment. However when diagnosed with insignificant cancer a large proportion of patients request treatment in case a more significant cancer is present. A prostate cancer detection pathway that finds significant cancers while avoiding the diagnosis of insignificant cancer is a major unmet need.

The potential implications of this trial include:

* A redefining of the prostate cancer diagnostic pathway
* A reduction in the number of patients undergoing prostate biopsy
* A reduction in the number of biopsy cores taken per patient
* A reduction in biopsy-related sepsis, pain and other side effects
* A reduction in the over-diagnosis of clinically insignificant prostate cancer
* A reduction of the economic burden of diagnosing and treating prostate cancer

Conditions

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Prostate Neoplasm

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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MRI-arm

Men in this arm will undergo multi-parametric MRI. In the presence of a suspicious area, a man will undergo MRI-targeted biopsy with cores targeted to the suspicious lesion. In the absence of a suspicious area, no biopsy will be taken.

Group Type EXPERIMENTAL

MRI

Intervention Type DEVICE

This will be a multi-parametric MRI of the prostate

MRI-targeted biopsy

Intervention Type PROCEDURE

This will be a biopsy targeted to suspicious areas on the MRI

TRUS-biopsy arm

Men in this arm undergo standard 12-core trans-rectal ultrasound guided prostate biopsy

Group Type ACTIVE_COMPARATOR

TRUS-biopsy

Intervention Type PROCEDURE

This will be a standard 12 core trans-rectal prostate biopsy

Interventions

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MRI

This will be a multi-parametric MRI of the prostate

Intervention Type DEVICE

MRI-targeted biopsy

This will be a biopsy targeted to suspicious areas on the MRI

Intervention Type PROCEDURE

TRUS-biopsy

This will be a standard 12 core trans-rectal prostate biopsy

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Men at least 18 years of age referred with clinical suspicion of prostate cancer who have been advised to have a prostate biopsy
2. Serum PSA ≤ 20ng/ml within the previous 3 months
3. Suspected stage ≤ T2 on rectal examination (organ-confined prostate cancer) within the previous 3 months
4. Fit to undergo all procedures listed in protocol
5. Able to provide written informed consent

Exclusion Criteria

1. Prior prostate biopsy
2. Prior treatment for prostate cancer
3. Contraindication to MRI (e.g. claustrophobia, pacemaker, estimated glomerular filtration rate ≤ 50mls/min)
4. Contraindication to prostate biopsy
5. Men in whom artifact would reduce the quality of the MRI
6. Previous hip replacement surgery, metallic hip replacement or extensive pelvic orthopaedic metal work
7. Unfit to undergo any procedures listed in protocol
Minimum Eligible Age

18 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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National Institute for Health Research, United Kingdom

OTHER_GOV

Sponsor Role collaborator

University Hospital, Lille

OTHER

Sponsor Role collaborator

Radboud University Medical Center

OTHER

Sponsor Role collaborator

London North West Healthcare NHS Trust

OTHER

Sponsor Role collaborator

Royal Free Hospital NHS Foundation Trust

OTHER

Sponsor Role collaborator

Sunnybrook Health Sciences Centre

OTHER

Sponsor Role collaborator

University College London Hospitals

OTHER

Sponsor Role collaborator

University Ghent

OTHER

Sponsor Role collaborator

Helsinki University Central Hospital

OTHER

Sponsor Role collaborator

Jewish General Hospital

OTHER

Sponsor Role collaborator

University of Roma La Sapienza

OTHER

Sponsor Role collaborator

Göteborg University

OTHER

Sponsor Role collaborator

Erasmus Medical Center

OTHER

Sponsor Role collaborator

Hunter Holmes Mcguire Veteran Affairs Medical Center

FED

Sponsor Role collaborator

University Hospital Heidelberg

OTHER

Sponsor Role collaborator

University Hospital, Aachen

OTHER

Sponsor Role collaborator

Hampshire Hospitals NHS Foundation Trust

OTHER

Sponsor Role collaborator

Princess Alexandra Hospital NHS Trust

OTHER

Sponsor Role collaborator

San Raffaele University Hospital, Italy

OTHER

Sponsor Role collaborator

M.D. Anderson Cancer Center

OTHER

Sponsor Role collaborator

University Hospital Southampton NHS Foundation Trust

OTHER

Sponsor Role collaborator

University of Oulu

OTHER

Sponsor Role collaborator

The Whittington Hospital NHS Trust

OTHER_GOV

Sponsor Role collaborator

University Hospital of Cologne

OTHER

Sponsor Role collaborator

Mayo Clinic

OTHER

Sponsor Role collaborator

Centro de Urologia Argentina

UNKNOWN

Sponsor Role collaborator

Weill Medical College of Cornell University

OTHER

Sponsor Role collaborator

University of Chicago

OTHER

Sponsor Role collaborator

University Hospital, Bordeaux

OTHER

Sponsor Role collaborator

University College, London

OTHER

Sponsor Role lead

Responsible Party

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Veeru Kasivisvanathan

Study Coordinator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Caroline Moore, MD FRCS

Role: STUDY_CHAIR

University College Hospital London and University College London

Mark Emberton, MD FRCS

Role: STUDY_CHAIR

University College Hospital London and University College London

Locations

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University College Hospitals

London, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Kasivisvanathan V, Rannikko AS, Borghi M, Panebianco V, Mynderse LA, Vaarala MH, Briganti A, Budaus L, Hellawell G, Hindley RG, Roobol MJ, Eggener S, Ghei M, Villers A, Bladou F, Villeirs GM, Virdi J, Boxler S, Robert G, Singh PB, Venderink W, Hadaschik BA, Ruffion A, Hu JC, Margolis D, Crouzet S, Klotz L, Taneja SS, Pinto P, Gill I, Allen C, Giganti F, Freeman A, Morris S, Punwani S, Williams NR, Brew-Graves C, Deeks J, Takwoingi Y, Emberton M, Moore CM; PRECISION Study Group Collaborators. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018 May 10;378(19):1767-1777. doi: 10.1056/NEJMoa1801993. Epub 2018 Mar 18.

Reference Type DERIVED
PMID: 29552975 (View on PubMed)

Kasivisvanathan V, Jichi F, Klotz L, Villers A, Taneja SS, Punwani S, Freeman A, Emberton M, Moore CM. A multicentre randomised controlled trial assessing whether MRI-targeted biopsy is non-inferior to standard transrectal ultrasound guided biopsy for the diagnosis of clinically significant prostate cancer in men without prior biopsy: a study protocol. BMJ Open. 2017 Oct 12;7(10):e017863. doi: 10.1136/bmjopen-2017-017863.

Reference Type DERIVED
PMID: 29025845 (View on PubMed)

Other Identifiers

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DRF-2014-07-146

Identifier Type: -

Identifier Source: org_study_id

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