ExosomeDx in MRI-negative Men With High PSA

NCT ID: NCT06966089

Last Updated: 2025-05-11

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

425 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-08-31

Study Completion Date

2026-08-31

Brief Summary

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Magnetic resonance imaging (MRI) has become the current standard of care in risk stratifying men with an elevated Prostate-specific antigen (PSA) to determine who needs to undergo prostate biopsy, which is invasive and carries a 3-5% risk of serious infection. Recent data shows the negative predictive value of MRI to be only 77%, indicating that some men may inappropriately forego biopsy based on a negative MRI. Urinary exosomes can be captured and analyzed by the ExosomeDx (ExoDx) Prostate test, a urine based, gene signature derived from PCA3 (prostate cancer antigen 3) and ERG (erythroblast transformation-specific related gene), and SPDEF (SAM pointed domain-containing ETS transcription factor); ExoDx carries a 90% negative predictive value.

The use of ExoDx test among patients with negative MRIs has the potential to improve the risk stratification of patients with an elevated PSA in a way that the Urologist can more accurately determine which patients need to undergo prostate biopsy. In doing so, the Urologist can better risk-stratify which patients should undergo prostate biopsy and be exposed to the associated potential risks, and also be more confident about the safety of foregoing biopsy in those patients with negative MRI and negative ExoDx test.

Detailed Description

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Conditions

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Prostate Cancer

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

A prospective diagnostic test design will be used to compare the sensitivity of ExoDx with PSA density (H0: SensitivityPSA Density ≤ SensitivityExoDx versus H1: SensitivityPSA Density \> SensitivityExoDx) and the specificity (H0: Specificity PSA Density ≤ Specificity ExoDxversus H1: Specificity PSA Density \> Specificity ExoDx).
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Participants with elevated or rising PSA

Participants who have been diagnosed with an elevated or rising PSA as determined by their urologist, and who have a negative (PIRADS 1 or 2) prostate MRI will be offered enrollment in this trial. ExoDx Study Kit will be collected onsite. Participants will then be scheduled for transrectal ultrasound-guided or transperineal 12-core prostate biopsy as per the standard diagnostic practice.

Group Type EXPERIMENTAL

Urinary ExoDx test

Intervention Type DEVICE

A urine sample for ExoDx Study Kit will be collected onsite and shipped to Exosome Diagnostic's laboratory.

Transrectal ultrasound-guided prostate biopsy

Intervention Type DIAGNOSTIC_TEST

Participants will be scheduled for transrectal ultrasound-guided prostate biopsy as per the standard diagnostic practice after urinary test.

Transperineal 12-core prostate biopsy

Intervention Type DIAGNOSTIC_TEST

Participants will be scheduled for transperineal 12-core prostate biopsy as per the standard diagnostic practice after urinary test.

Interventions

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Urinary ExoDx test

A urine sample for ExoDx Study Kit will be collected onsite and shipped to Exosome Diagnostic's laboratory.

Intervention Type DEVICE

Transrectal ultrasound-guided prostate biopsy

Participants will be scheduled for transrectal ultrasound-guided prostate biopsy as per the standard diagnostic practice after urinary test.

Intervention Type DIAGNOSTIC_TEST

Transperineal 12-core prostate biopsy

Participants will be scheduled for transperineal 12-core prostate biopsy as per the standard diagnostic practice after urinary test.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

To be eligible to participate in this study, an individual must meet all the following criteria;

* Willingness to participate and provide signed and dated informed consent form
* Male (sex)
* Age ≥ 18 years
* PSA screen-eligible, per investigator discretion

* 45-75 years of age for average risk
* 40-75 years of age for high risk
* PSA ≥ 2.0 ng/mL and ≤ 10.0 ng/mL
* MRI PIRADS score of 1 or 2
* ECOG 0-1
* Must have a negative urine culture prior to biopsy
* No prior prostate biopsies within the last 5 years (biopsy-naïve)
* Willingness to undergo a prostate biopsy as part of the diagnostic work-up
* Digital rectal exam with no palpable nodules

Exclusion Criteria

An individual who meets any of the following criteria will be excluded from participation in this study;

* Prior or current histologic or pathologic confirmed diagnosis of prostate cancer
* Prior transrectal ultrasound within the last 5 years
* Any prior cancer diagnosis within the last 5 years
* On immunosuppression or predefined immunosuppressed state
* A known coagulopathy predisposition to bleeding
* Diagnoses of any 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, in the opinion of the investigator, would limit compliance with study requirements
* Cognitive inability or psychiatric conditions that preclude informed decision making or compliance with study requirements (per investigator discretion)
Minimum Eligible Age

18 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Bio-Techne Corporation

UNKNOWN

Sponsor Role collaborator

Icahn School of Medicine at Mount Sinai

OTHER

Sponsor Role lead

Responsible Party

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Nikhil Waingankar

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nikhil Waingankar, MD

Role: PRINCIPAL_INVESTIGATOR

Icahn School of Medicine at Mount Sinai

Locations

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Mount Sinai Beth Israel / Union Square

New York, New York, United States

Site Status

Mount Sinai West

New York, New York, United States

Site Status

Mount Sinai Morningside

New York, New York, United States

Site Status

Mount Sinai Hospital

New York, New York, United States

Site Status

Mount Sinai Queens

New York, New York, United States

Site Status

Mount Sinai Brooklyn

New York, New York, United States

Site Status

Countries

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United States

Central Contacts

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Nikhil Waingankar, MD

Role: CONTACT

(718) 808-7777

Facility Contacts

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Nikhil Waingankar, MD

Role: primary

718-808-7777

Other Identifiers

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STUDY-24-00010

Identifier Type: -

Identifier Source: org_study_id

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