Positron Emission Tomography / Magnetic Resonance Imaging (PET/MRI) Guided Biopsy in Men With Elevated PSA

Irene Burger

Status: Completed

Conditions: Prostate Cancer

Treatments: Drug: [68Ga]PSMA-11; Drug: [18F]PSMA-1007

Study type: Interventional

Funder types: Other

Identifiers

NCT03187990

KEK-ZH-NR: 2017-00016

Details and patient eligibility

About

In 22% of patients with elevated Prostate-specific antigen (PSA) MRI guided biopsy will not detect significant prostate cancer (PCA) (defined as either: Gleason score (GS) ≥ 3+4 or tertiary pattern 5, or final stage ≥ pT3a and/or pN1). Therefore this study evaluates the ability of [68Ga]PSMA PET/MRI to detect and localize significant primary PCA to accurately direct prostate needle biopsy using the Gleason score from the histology of the core biopsies as standard of truth.

Full description

In this open label, single center, non-randomized, diagnostic study we plan to include 40 men with elevated PSA (ages 30-50 PSA >2.5 ng/mL; ages 50-80 PSA > 4ng/mL), which are assigned to a MRI guided biopsy.

These patients will undergo one additional PET/MRI scan with [68Ga]PSMA within two to three weeks before the biopsy (Arm A), or in case of an unclear/negative MRI scan but positive biopsy two to three weeks after biopsy (Arm B). In Arm A a radiologist will delineate the suspected areas on (A) multiparametric magnetic resonance image (mpMRI) and a nuclear medicine physician will delineate and color code the suspicious areas on the PET/MRI: (B) [68Ga]PSMA. The images will be loaded into the BiopSee® system. Lesions positive on both modalities will be labeled as "AB". Every suspicious lesion will be targeted with 3 cores. A maximum of 3 targets will be selected per patient.

For arm B: PET/MRI results will be correlated with the template biopsy results.

The data analysis of Arm A and Arm B will be identical. For the analysis the Gleason score from the histology of the core biopsies will serve as standard of truth.

After completion of the PET/MR study part - an amendment for PET/CT was submitted to the local ethics commity and acknowledged to include 10 more participants with PSMA PET/CT to investigate the use of PET/CT guided biopsy and intraoperative verivication of the target with a gamma counter.

Enrollment: 52 patients

Sex: Male

Ages: 30 to 80 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

1. Previously undiagnosed patients with elevated PSA (ages 30-50 PSA >2.5 ng/mL; ages 50-80 PSA > 4ng/mL), eligible for prostate needle biopsy.
2. Patients can have negative prior needle biopsy(ies) for suspected prostate cancer
3. mpMRI with at least one suspicious target lesion (Arm A), or negative mpMRI but positive biopsy (Arm B).
4. Written informed consent
5. Age > 30

Exclusion criteria

1. Age> 80
2. Contraindication to MRI or prostate biopsy (e.g. extreme claustrophobia, metallic implants incompatible with MRI, anatomical contraindications, coagulopathy, severe medical comorbidity prohibiting halting of anticoagulation therapies)
3. Active urinary tract infection or indwelling catheter
4. Prior pelvic irradiation
5. Prior prostatectomy
6. Prior androgen deprivation hormonal therapy
7. Prostate biopsy within 8 weeks prior to study
8. Prior transurethral resection of the prostate (TURP)

Trial design

Primary purpose: Diagnostic

Allocation: Non-Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

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52 participants in 2 patient groups

PET/MRI before biopsy

Experimental group

Description:

Patients with suspected areas on mpMRI will undergo additional \[68Ga\]PSMA-11 PET/MRI scan with subsequent mpMRI and PET/MRI guided biopsy.

Treatment:

Drug: [18F]PSMA-1007

Drug: [68Ga]PSMA-11

PET/MRI after biopsy

Experimental group

Description:

Patients with unclear areas or a negative finding in the mpMRI for MRI guided biopsy but positive biopsy, which will undergo the additional \[68Ga\]PSMA-11 PET/MRI scan with \[68Ga\]PSMA.

Treatment:

Drug: [68Ga]PSMA-11