Accuracy of 18F-rhPSMA-7.3 PET/ MRI for Prediction of Lymph Node Metastasis in Localized High-Risk Prostate Cancer

Mayo Clinic

Status

Enrolling

Conditions

Stage I Prostate Cancer AJCC v8

Localized Prostate Carcinoma

Stage IVA Prostate Cancer AJCC v8

Stage III Prostate Cancer AJCC v8

Oligometastatic Prostate Carcinoma

Stage II Prostate Cancer AJCC v8

Treatments

Procedure: Biospecimen Collection

Procedure: Magnetic Resonance Imaging

Procedure: Positron Emission Tomography

Procedure: Laparoscopic Radical Prostatectomy with Robotics

Procedure: Computed Tomography

Other: Electronic Health Record Review

Procedure: Bone Scan

Other: Flotufolastat F-18 Gallium

Procedure: Bilateral Pelvic Lymph Node Dissection

Study type

Interventional

Funder types

Other

Identifiers

NCT06389786

NCI-2024-03306 (Registry Identifier)

23-009377 (Other Identifier)

MC230504 (Other Identifier)

Details and patient eligibility

About

This clinical trial evaluates the use of an imaging scan (18F-rhPSMA-7.3 positron emission tomography [PET]/magnetic resonance imaging [MRI]) for identifying patients who are at risk of having their disease spread to the lymph nodes in those undergoing radical prostatectomy for prostate cancer that has not spread to other parts of the body (localized). Prostate specific membrane antigen (PSMA) PET/computed tomography (CT) has emerged as an option to stage newly diagnosed high risk prostate cancer patients. PSMA PET/CT has demonstrated improved diagnostic accuracy for identifying metastasis. PET is procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body. MRI is procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. This study may help researchers learn whether 18F-rhPSMA-7.3 PET/ MRI may improve predicting which patients are at risk of lymph node metastases and who are suitable candidates for pelvic lymph node dissection in patients with localized high-risk prostate cancer undergoing radical prostatectomy.

Full description

PRIMARY OBJECTIVE:

I. To investigate the diagnostic ability of flotufolastat F-18 gallium (18F-rhPSMA-7.3) PSMA PET/MRI prior to radical prostatectomy in newly diagnosed, high-risk prostate cancer patients.

SECONDARY OBJECTIVES:

I. Calculating the specificity, positive-predictive value, and negative-predictive value for the detection of lymph node positivity.

II. Investigating the rates of biochemical recurrence (BCR) as measured by post-operative prostate specific antigen (PSA) (PSA > 0.20) at pre-defined timepoints in patients.

OUTLINE:

Patients receive 18F-rhPSMA-7.3 intravenously (IV) and undergo PET/MRI up to 30 days prior to standard of care (SOC) robotic radical prostatectomy with bilateral pelvic lymph node dissection. Patients also undergo CT/MRI or bone scan/PET, as well as tissue collection during screening.

Upon completion of study treatment, patients are followed up at 6 weeks, 3 months, 9 months, and 12 months post-surgery.

Enrollment

50 estimated patients

Sex

Male

Ages

30 to 85 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Male subjects ≥ 30 and ≤ 85 years old
Primary diagnosis of prostate cancer selected for surgical intervention (radical prostatectomy with extended lymph node dissection)
Primary diagnosis of untreated American Urological Association (AUA) guidelines high-risk localized prostate cancer, hormone-naïve prostate cancer via contrast enhanced prostate MRI + tissue sampling
Planned elective radical prostatectomy with extended pelvic lymph node dissection
Clinical oligometastatic disease with ≤ 3 nodes positive on preoperative standard of care imaging of prostate region within 6 months of surgery
Patient agrees to comply with the investigator instructions
Patient agrees to comply with the follow-up surveillance schedule
Have ability to provide full written consent

Exclusion criteria

High-risk cancer planned for neoadjuvant therapy
Patients with a history of more than two weeks treatment with immunosuppressants (including systemic corticosteroids), cytotoxic chemotherapy within one month prior to initial screening, or who receive such medications during the screening period, or who are anticipated to require such medications during the course of the study
Patients that have had prior hormonal therapy such as Lupron or oral antiandrogens ≤ 12 weeks prior to registration
Clinical oligometastatic disease with > 3 nodes positive preoperative standard of care imaging of prostate region
Previous history of pelvic radiation
Patients with obesity defined as body mass index (BMI) > 40 kg/m^2
History of prior laparoscopic inguinal hernia repair with mesh
Scheduled at the time of screening to undergo chemotherapy, radiation, hormone therapy, or open surgery during the study period
Inability to lie still for 75 minutes during 18F-rhPSMA-7.3 PSMA PET-MRI imaging
Any neurologic disorder or psychiatric disorder that might confound postsurgical assessments
Has any condition(s), which seriously compromises the subject's ability to participate in this study, sign consent, or has a known history of poor adherence with medical treatment
Received administration of an investigational drug within 30 days prior to study registration, and/or has planned administration of another investigational product or procedure during participation in this study

Trial design

Primary purpose

Screening

Allocation

N/A

Interventional model

Single Group Assignment

Masking

None (Open label)

50 participants in 1 patient group

Screening (18F-rhPSMA-7.3 PET/MRI)

Experimental group

Description:

Patients receive 18F-rhPSMA-7.3 IV and undergo PET/MRI up to 30 days prior to SOC robotic radical prostatectomy with bilateral pelvic lymph node dissection. Patients also undergo CT/MRI or bone scan/PT, as well as tissue collection during screening.

Treatment: