Targeted Fusion Biopsy of the Prostate

Emory University

Status and phase: Completed; Phase 2

Conditions: Prostatic Neoplasms

Treatments: Procedure: Standard transrectal ultrasound (TRUS) guided biopsy; Procedure: Three-dimensional ultrasound-guided biopsy; Drug: FACBC PET-CT Scan

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT02744534

IRB00080287

R01CA204254 (U.S. NIH Grant/Contract)

R01CA156775 (U.S. NIH Grant/Contract)

R21CA176684 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The purpose of this study is to see if using Positron Emission Tomography (PET) scan and transrectal ultrasound (TRUS) guided biopsy together (creating a 3-dimensional ultrasound) will detect prostate cancer more accurately than the standard 2-dimensional approach which uses only the TRUS to guide the biopsy.

Full description

The objective of the proposed study is to evaluate a molecular image directed, three-dimensional (3D) ultrasound guided biopsy system in human patients. Prior studies have shown that Positron Emission Tomography (PET)/Computed Tomography (CT) imaging with the PET molecular imaging agent, a synthetic amino acid, anti-1-amino-3-[18F]fluorocyclobutane-1- carboxylic acid (FACBC), is more sensitive than the FDA-approved prostate specific membrane antigen single-photon emission computed tomography (SPECT) radiotracer in prostate cancer detection. FACBC images showed higher focal uptake in tumor foci than in normal prostate and thus could be ideal information to direct targeted biopsy of the prostate. This targeted biopsy system has a unique feature that PET/CT images can be registered with 3D ultrasound images, as a result, a suspicious PET lesion is superimposed over the real-time ultrasound data; and the fused image is then used to direct biopsy needles to tumor targets.

The hypothesis of the study is that PET/ultrasound fusion targeted biopsy can detect more cancer per core than the standard 12-core TRUS guided biopsy.

The specific aims include:

1. To perform PET/CT directed, 3D ultrasound-guided biopsy and determine if fusion targeted biopsy can detect more cancers than 2D transrectal ultrasound (TRUS)-guided biopsy
2. To develop the workflow for performing deformable registration and fusion of PET/CT and 3D ultrasound images of human patients

Thirty six patients, who have suspicion of recurrent prostate cancer after definitive therapy such as radiotherapy, will be recruited into this study. At least half of the patients will have positive imaging findings and will undergo 2D TRUS-guided biopsy as well as PET/ultrasound fusion biopsy. The proposed study will be the first-in-human trial that uses PET/CT imaging to direct 3D ultrasound-guided biopsy of the prostate. The multimodality imaging approach will combine the high sensitivity from PET and real-time information from ultrasound for improved cancer detection.

Enrollment: 21 patients

Sex: Male

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Have been originally diagnosed with prostate carcinoma and have undergone definitive non-prostatectomy therapy for localized disease
• There is suspicion of recurrent prostate carcinoma as defined by: Older American Society for Radiation Oncology (ASTRO) criteria of three consecutive rises of prostate-specific antigen (PSA) or earlier if clinically appropriate, and/or nadir + 2.0 ng/ml (Radiation Therapy Oncology Group (RTOG)-ASTRO Phoenix criteria)
• Able to provide written informed consent

Exclusion criteria

• Cryotherapy, external beam radiation, or high intensity focused ultrasound (HIFU) within the past year
• Brachytherapy within the past two years (to rule out a transient rise in PSA)
• Prostate biopsy within the past month (to decrease a false positive result due to inflammation)
• Not otherwise eligible for prostate biopsy

Trial design

Primary purpose: Diagnostic

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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21 participants in 2 patient groups

Abnormalities found with FACBC PET-CT

Experimental group

Description:

All participants with suspected recurrence of prostate cancer will have the FACBC PET-CT scan performed. Participants with abnormal FACBC PET-CT scan results will have a PET/ultrasound fusion targeted prostate biopsy followed a standard of care prostate biopsy.

Treatment:

Procedure: Three-dimensional ultrasound-guided biopsy

Drug: FACBC PET-CT Scan

Procedure: Standard transrectal ultrasound (TRUS) guided biopsy

No abnormalities found with FACBC PET-CT

Active Comparator group

Description:

All participants with suspected recurrence of prostate cancer will have the FACBC PET-CT scan performed. Participants without abnormal FACBC PET-CT scan results will have a standard of care prostate biopsy.

Treatment:

Drug: FACBC PET-CT Scan

Procedure: Standard transrectal ultrasound (TRUS) guided biopsy