Diagnosing Clinically Significant Prostate Cancer In African American and White Men With Elevated PSA

NCT ID: NCT03234556

Last Updated: 2025-12-22

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

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

288 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-09-25

Study Completion Date

2028-05-23

Brief Summary

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This randomized phase II trial studies how well systematic random biopsy or magnetic resonance imaging (MRI)-ultrasound image (US) fusion biopsy work in diagnosing prostate cancer in patients with elevated prostate specific antigen. Systematic random biopsy and MRI-US fusion biopsy may work better in improving the accuracy of prostate cancer detection.

Detailed Description

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PRIMARY OBJECTIVES:

I. To compare the detection of clinically significant prostate cancer (CSPCa) in Arm 1 versus Arm 2.

II. To compare between African American (AA) and white men the probability of developing CSPCa within three years of initial biopsy at the start of the study.

SECONDARY OBJECTIVES:

I. To determine complications and patient morbidity associated with either systematic random prostate biopsy (SR-Bx) versus (vs) magnetic resonance imaging-ultrasound image fusion biopsy (MRUS-Bx) + SR-Bx.

TERTIARY OBJECTIVES:

I. To compare Gleason score between MRUS-Bx and radical prostatectomy (RP) specimen among men who elect RP (\~110 in the randomized controlled trial \[RCT\]).

II. To assess within Arm 1 the detection of CSPCa three months after SR-Bx among men initially diagnosed with clinically insignificant prostate cancer (CinsPCa) or no cancer.

III. To identify among men invited to participate and those actually enrolled in the RCT: determinants of study participation.

IV. To identify among men invited to participate and those actually enrolled in the RCT: determinants of treatment decision (active surveillance \[AS\] vs radiation vs RP) including the diagnostic method.

OUTLINE: Patients are randomized into 1 of 2 arms.

ARM I: SR-Bx group

* Patients undergo SR-Bx

* If SR-Bx doesn't reveal clinically significant cancer, then MRI in 3 months, and if lesion is present (PIRADS ≥ 3) schedule for MRUS-Bx.
* If there is no lesion, then no biopsy - schedule MRI in 12 months after the initial MRI.

ARM II: MRUS-Bx group

* Patients undergo MRI. Must be scheduled at least 1 day before MRUS Biopsy.

* MRI shows no lesion present (PIRADS 1-2): no MRUS-Bx, schedule for SR-Bx only.
* MRI lesion present (PIRADS ≥ 3): schedule for MRUS-Bx, which will be done first and followed immediately after by SR-Bx.

FOLLOW UP:

After completion of procedure, patients are followed up at 2-4 weeks, 3, 6, 9, and 12 months, and then periodically for up to 5 years.

Conditions

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Health Status Unknown Elevated PSA

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SCREENING

Blinding Strategy

NONE

Study Groups

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Arm I (SR-Bx)

Patients undergo SR-Bx. If SR-Bx doesn't reveal clinically significant cancer, then MRI will be done in 3 months, and if lesion is present (PIRADS ≥ 3) schedule for MRUS-Bx. If there is no lesion, then no biopsy. Schedule MRI in 12 months after the initial MRI.

Group Type ACTIVE_COMPARATOR

Biopsy of Prostate

Intervention Type PROCEDURE

Undergo SR-Bx

Laboratory Biomarker Analysis

Intervention Type OTHER

Correlative studies

Magnetic Resonance Imaging

Intervention Type DIAGNOSTIC_TEST

Undergo MRI

MRI Ultrasound Fusion Guided Biopsy

Intervention Type DIAGNOSTIC_TEST

Undergo MRUS-Bx

Arm II (MRI, MRUS-Bx, SR-Bx)

Patients undergo MRI. Must be scheduled at least one day before MRUS biopsy.

* If MRI shows no lesion present (PIRADS 1-2), then no MRUS-Bx. Schedule for SR-Bx only.
* If MRI shows lesion present (PIRADS ≥ 3), perform MRUS-Bx, which will be done first and followed immediately by SR-Bx.

Group Type EXPERIMENTAL

Biopsy of Prostate

Intervention Type PROCEDURE

Undergo SR-Bx

Laboratory Biomarker Analysis

Intervention Type OTHER

Correlative studies

Magnetic Resonance Imaging

Intervention Type DIAGNOSTIC_TEST

Undergo MRI

MRI Ultrasound Fusion Guided Biopsy

Intervention Type DIAGNOSTIC_TEST

Undergo MRUS-Bx

Interventions

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Biopsy of Prostate

Undergo SR-Bx

Intervention Type PROCEDURE

Laboratory Biomarker Analysis

Correlative studies

Intervention Type OTHER

Magnetic Resonance Imaging

Undergo MRI

Intervention Type DIAGNOSTIC_TEST

MRI Ultrasound Fusion Guided Biopsy

Undergo MRUS-Bx

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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Prostate Biopsy Prostatic Biopsy Magnetic Resonance Imaging Scan Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance MRI MRI Scan NMR Imaging NMRI Nuclear Magnetic Resonance Imaging Fusion Biopsy Fusion-Guided Biopsy MR Fusion Biopsy MRI-Ultrasound Fusion Biopsy MRI/Ultrasound Fusion Biopsy MRI/US Biopsy

Eligibility Criteria

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Inclusion Criteria

* Written informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization for release of personal health information

* Note: HIPAA authorization may be included in the informed consent or obtained separately
* Eastern Cooperative Oncology Group (ECOG) performance status of =\< 1 within 3 months (93 days) prior to being registered for protocol
* African-American or white men (Hispanic or non-Hispanic)
* Prostate biopsy-naive or a single negative biopsy
* Having elevated prostate specific antigen (PSA) (\> 2.5 ng/ml) and no palpable nodule on digital rectal exam (DRE)
* Ability to understand the willingness to sign a written informed consent
* Patients must be willing to undergo a radiologic imaging before and after biopsy of the prostate
* Patients must be willing to undergo a biopsy of the prostate

Exclusion Criteria

* Patients who have had chemotherapy or radiotherapy within 12 months of the study for other diagnoses not related to prostate cancer
* Patients receiving any other investigational agents
* Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
* Patients with active inflammatory bowel disease
* Patients who are unable to undergo MRI
* Patients who had any surgery of the prostate including TURP (transurethral resection of the prostate)
* Patients who had \> 1 prior prostate biopsy
Minimum Eligible Age

40 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

University of Southern California

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Inderbir Gill

Role: PRINCIPAL_INVESTIGATOR

University of Southern California

Locations

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USC / Norris Comprehensive Cancer Center

Los Angeles, California, United States

Site Status

University of Maryland

Baltimore, Maryland, United States

Site Status

Henry Ford Hospital Vattikuti Urology Institute

Detroit, Michigan, United States

Site Status

Memorial Sloan-Kettering Cancer Center

New York, New York, United States

Site Status

Countries

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United States

Other Identifiers

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NCI-2017-00890

Identifier Type: REGISTRY

Identifier Source: secondary_id

4P-16-7

Identifier Type: OTHER

Identifier Source: secondary_id

P30CA014089

Identifier Type: NIH

Identifier Source: secondary_id

View Link

R01CA205058

Identifier Type: NIH

Identifier Source: secondary_id

View Link

4P-16-7

Identifier Type: -

Identifier Source: org_study_id