Extended Systematic Versus Mri-Assisted pRostate Transperineal Biopsy

NCT ID: NCT04685928

Last Updated: 2025-05-06

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

NA

Total Enrollment

403 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-05-27

Study Completion Date

2024-09-24

Brief Summary

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This is a randomized controlled trial to evaluate the detection of clinically significant prostate cancer (csPCa) by MRI-targeted approach (MRI-arm) versus 24-core transperineal (TP) systematic biopsy (TP-arm). Clinically significant prostate cancer (csPCa) is defined as ISUP (International Society of Urogenital Pathology) Grade group ≥2 prostate cancer. Patients with elevated PSA 4-20 ng/mL with or without abnormal digital rectal examination (DRE) will be randomized in a 1:1 manner to MRI-arm or TP-arm. In the MRI-arm, multiparametric MRI prostate will be performed for each subject. MRI prostate is considered abnormal if PI-RADS (Prostate Imaging-Reporting and Data System, version 2.1) score is 3, 4 or 5. For subjects in MRI-arm with abnormal MRI, MRI-targeted biopsy will be performed, followed by 12-core systematic transperineal biopsy (sparing MRI-target). For subjects in MRI-arm with normal MRI, no biopsy is performed. For subjects in TP-arm, 24-core systematic transperineal biopsy will be performed without MRI guidance. The study flowchart is provided in Figure 1. The detection rates of csPCa will be compared between MRI-targeted biopsy plus 12-core systematic biopsy (in MRI-arm) versus TP-arm. The study hypothesis is MRI-guided prostate biopsy with 12-core systematic biopsy is superior to 24-core transperineal systematic biopsy in detection of csPCa.

Detailed Description

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The current study is a randomized controlled trial using a superiority design with the subjects randomized in 1:1 manner to either MRI-arm or TP-arm. In the MRI-arm, multiparametric MRI is performed for all subjects. If MRI is abnormal (PI-RADS score 3-5), 3-4 core targeted followed by 12-core systematic transperineal biopsies under local anaesthesia will be performed. If MRI is normal, no biopsy is performed. A 12-core systematic biopsy is also included in MRI-targeted biopsy as it has been shown in the Trio study that adding systematic biopsy increased the detection of csPCa.

In the TP-arm, no MRI will be performed, and all subjects will receive 24-core transperineal prostate biopsy under local anaesthesia. Patient will be followed up in clinic about 30 days after biopsy to review pathology result and complication.

Conditions

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Prostate Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized controlled trial, 1:1 allocation
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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MRI arm

MRI prostate with contrast, followed by MRI-guided biopsy under local anaesthesia only if MRI show suspicious lesion. Men with non-suspicious MRI will not receive a biopsy.

Group Type EXPERIMENTAL

MRI and MRI-guided prostate biopsy

Intervention Type DIAGNOSTIC_TEST

Multiparametric MRI prostates in the MRI arm will be performed using 1.5 or 3.0 Tesla scanner with a pelvic phased array coil and contrast injection. T2-weighted, diffusion weighted and dynamic contrast enhanced scans will be included and the reporting of MRI finding will be done according to PI-RADS (Prostate Imaging-Reporting and Data Systems) v2.1 recommendations. MRI-guided targeted biopsy will be performed by Urologists experienced in MRI-guided biopsy for men with PI-RADS score 3-5.

TP-arm Systematic biopsy

24-core Systematic transperineal prostate biopsy under local anaesthesia

Group Type ACTIVE_COMPARATOR

TP-arm Systematic biopsy

Intervention Type DIAGNOSTIC_TEST

Transperineal 24-core biopsy using a free-hand technique under local anaesthesia will be performed under transrectal ultrasound guidance for men in this arm

Interventions

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MRI and MRI-guided prostate biopsy

Multiparametric MRI prostates in the MRI arm will be performed using 1.5 or 3.0 Tesla scanner with a pelvic phased array coil and contrast injection. T2-weighted, diffusion weighted and dynamic contrast enhanced scans will be included and the reporting of MRI finding will be done according to PI-RADS (Prostate Imaging-Reporting and Data Systems) v2.1 recommendations. MRI-guided targeted biopsy will be performed by Urologists experienced in MRI-guided biopsy for men with PI-RADS score 3-5.

Intervention Type DIAGNOSTIC_TEST

TP-arm Systematic biopsy

Transperineal 24-core biopsy using a free-hand technique under local anaesthesia will be performed under transrectal ultrasound guidance for men in this arm

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

1. Men ≥18 years of age
2. Clinical suspicion of prostate cancer and indicated for prostate biopsy
3. Serum Prostate-specific antigen (PSA) 4-20 ng/mL
4. Digital rectal examination ≤ cT2 (organ confined cancer)
5. Able to provide written informed consent

Exclusion Criteria

1. Prior prostate biopsy
2. Past or current history of prostate cancer
3. MRI prostate performed within past 5 years
4. Contraindicated to undergo MRI scan (e.g. pacemaker in-situ, claustrophobia, estimated glomerular filtration rate \< 50ml/min in serum renal function test within 3 months)
5. Contraindicated to transperineal prostate biopsy: active urinary tract infection, fail insertion of transrectal ultrasound probe into rectum (abdominal perineal resection, anal stenosis), fail to be placed in lithotomy position, uncorrectable coagulopathy, antiplatelet or anticoagulant which cannot be stopped (keep aspirin before and after biopsy is permitted)
Minimum Eligible Age

18 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Chinese University of Hong Kong

OTHER

Sponsor Role lead

Responsible Party

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CHIU Ka Fung Peter

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Peter Ka-Fung CHIU, FRCS, PhD

Role: PRINCIPAL_INVESTIGATOR

Prince of Wales Hospital, The Chinese University of Hong Kong

Locations

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Kwong Wah Hospital

Hong Kong, , Hong Kong

Site Status

North District Hospital

Hong Kong, , Hong Kong

Site Status

Pamela Youde Nethersole Eastern Hospital

Hong Kong, , Hong Kong

Site Status

Prince of Wales Hospital

Hong Kong, , Hong Kong

Site Status

Princess Margaret Hospital

Hong Kong, , Hong Kong

Site Status

Queen Elizabeth Hospital

Hong Kong, , Hong Kong

Site Status

Queen Mary Hospital, The University of Hong Kong

Hong Kong, , Hong Kong

Site Status

United Christian Hospital

Hong Kong, , Hong Kong

Site Status

Countries

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Hong Kong

References

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Related Links

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Other Identifiers

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CRE 2020.569

Identifier Type: -

Identifier Source: org_study_id

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