The Value of Dual-parametric Magnetic Resonance Combined with Regional Saturation Biopsy in Patients with Suspected Prostate Cancer

Peking University

Status: Not yet enrolling

Conditions: Prostate Cancer

Treatments: Procedure: Follow up if MRI is negative; Procedure: Systematic biopsy if MRI is negative

Study type: Interventional

Funder types: Other

Identifiers

NCT06824259

bpMRIRSB

Details and patient eligibility

About

The aim of this study was to investigate the value of dual-parameter magnetic resonance imaging(bpMRI) combined with regional saturation biopsy in the diagnosis of prostate cancer by means of a prospective randomized controlled study.

The main questions it aims to answer are:

Can bpMRI guide the timing of prostate puncture and avoid unnecessary prostate biopsy? Effectiveness of focal saturation biopsy versus systemic biopsy + targeted biopsy.

Enrollment: 400 estimated patients

Sex: Male

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Be 18 years of age or older.

2. Compliance with clinical guidelines for indications for prostate puncture:

   • suspicious prostate nodule detected on rectal palpation;
   • suspicious lesion detected by transrectal ultrasound or magnetic resonance;
   • tPSA > 10 ng/mL;
   • tPSA 4-10 ng/mL with f/t < 0.16 or PSAD > 0.15.

3. Complete sequence of bpMRI of the prostate at our institution;

Exclusion criteria

1. tPSA >50ng/mL;
2. Presence of contraindications to prostate puncture and inability to tolerate prostate puncture;
3. reatment with radiotherapy, chemotherapy and surgery before prostate puncture;
4. History of prostate cancer;
5. Prostate multiparametric magnetic resonance images of poor quality or some sequences are missing.

Trial design

Primary purpose: Diagnostic

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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400 participants in 2 patient groups

MRI negative without biopsy

Experimental group

Description:

If a lesion with a PI-RADS score of 3 or higher was identified during the initial examination, a regional saturation biopsy of the prostate was conducted, as clinical suspicion of prostate cancer had been raised. Should the initial prostate biopsy yield negative results, the patient would be placed in the follow-up cohort. Targeted biopsy in conjunction with a 12-needle systematic biopsy would only be performed in cases where there was high suspicion of MRI persistence (a PI-RADS v2.1 score of 4 or 5) or if the lesion showed signs of progression. If no lesions with a PI-RADS v2.1 score of 3 or higher were detected during the initial examination, the patients would be entered into the follow-up cohort. Reginal saturation biopsy would be performed when MRI showed progression. If the initial prostate biopsy was negative, the patient would again be entered into the follow-up cohort.

Treatment:

Procedure: Follow up if MRI is negative

MRI negative with systemic biopsy

Active Comparator group

Description:

Focal saturation biopsy of the prostate was performed if a PI-RADS v2.1 score ≥3 lesion was detected during the initial examination. If no PIRADS v2.1 score ≥3 lesions were identified, a 12-needle systematic biopsy was performed. If the initial prostate biopsy was negative for prostate cancer, it was entered into the follow-up cohort. When the following clinical indications for repeat biopsy were met ① initial biopsy pathology showed no evidence of malignancy, but atypical small follicular hyperplasia was found, or high-grade epithelial neoplasia in more than 3 needles, with atypical glands visible in the surrounding area present; ② review of persistent elevation of serum PSA or abnormalities in the imaging follow up; and ③ review of serum PSA 4\~10 ng/ml in conjunction with f/t PSA, PSAD, PSAV, and PHI, abnormal rectal digital examination or other imaging findings, then target biopsy combined with 12-needle systemic biopsy was performed.

Treatment:

Procedure: Systematic biopsy if MRI is negative