Prostate Cancer Detection Rates of Standard Transrectal Prostate Biopsy and MR-guided Fusion Transrectal Prostate Biopsy

August 28, 2020 updated by: Abdullah Demirtas, TC Erciyes University

Comparison of Prostate Cancer Detection Rates of Standard Transrectal Prostate Biopsy and Multiparametric Prostate MR Guided MR-US Fusion Transrectal Prostate Biopsy

Prostate cancer is the most frequent cancer in men. Today serum prostate specific antigen (PSA) level and digital rectal examination (DRE) are routinely used for screening of prostate cancer. In the case of higher PSA levels and/or abnormal DRE, 10-12 core standard transrectal prostate biopsy (STRUS-B) is preferred method.Most of the pathological T1 stage tumours are diagnosed by this method. But as the prostate volume increases, cancer detection rate of STRUS-B decreases.In the last decade multiparametric prostate magnetic resonance imaging (mpMR) has gained importance in the diagnosis of prostate cancer beside the staging. Now it is possible to biopsies from lesions which are suspicious for cancer in mpMR. Recent studies have shown that mpMR guided prostate biopsies either transrectally or perineally have better cancer detection rates comparing STRUS-B, especially in patients with history of negative previous biopsy. But its use in biopsy naive settings is not recommended.In this study it is aimed to compare cancer detection rate of MR guided MR-US fusion transrectal prostate biopsy with STRUS-B.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

A histopathological evaluation of STRUS-B materials based on suspicious DRE findings and high or increasing PSA levels is the gold standard in prostate cancer diagnosis. However, the fact that approximately one-third of malignant prostate lesions is isoechoic and cannot be detected using conventional grayscale transrectal ultrasonography (TRUS) decreases the sensitivity rates of STRUS-B. These restrictions on the use of TRUS have encouraged urologists to use new methods to diagnose prostate cancer. One of these methods is the biopsy of lesions defined using mpMR, which has been widely used for the past 10 years. An MR targeted biopsy can be performed cognitively under MR guidance or using ultrasound devices with fusion software that can combine MR images with sonographic images. mpMR targeted biopsies are recommended in the current clinical practice for re-biopsies of patients who had previous negative biopsy but clinically suspected of cancer, follow-up biopsies of active surveillance, and biopsies of patients who are suspected to have recurrence after local minimally invasive treatment, such as radiotherapy and high-intensity focused ultrasonography. Recent studies showed that the cancer detection rate of mpMRIguided prostate biopsy is between 33.7% and 79.5%, which is higher than that of standard 12-core transrectal biopsy. However, the number of studies evaluating the use of MR targeted prostate biopsy in biopsy naive patients is limited.

In this study it is aimed to compare cancer detection rates of STRUS-B and MR guided MR-US fusion transrectal prostate biopsy in the biopsy naive patient setting.

100 patients will be randomized to STRUS-B arm and another 100 to fusion arm. In the standard arm patients who have high PSA levels and/or suspicious DRE will be undertaken STRUS-B. In the study arm all patients will undergo a multiparametric prostate MR without endorectal coils. MRI will be performed by Siemens Magnetom(Trade mark) 1.5 T (Siemens Medical Solutions, Pennsylvania, USA) MRI system. The images wi,ll be reviewed by an experienced uro-radiologist who has no detailed clinical information about the patients. Suspected areas in T2, T1 contrast, and diffusion-weighted images of multiparametric MRI were reported according to Prostate Imaging Reporting and Data System Version-2 (PIRADS v2). In cases of multiple lesions with different PIRADS scores, the lesion with the highest PIRADS score will be accepted as dominant lesion. Biopsy procedures will be performed under local anesthesia or sedoanalgesia. However, sedoanalgesia will be preferred if the patient could not tolerate pain during the penetration of US probe due to low pain threshold or anal canal stricture due to previous rectal surgeries. The procedure will be performed in outpatient clinic conditions. Transrectal ultrasonography will be performed by using an ultrasonography system with rigid fusion software (LOGIQ E9; General Electric, Massachusetts, USA) when patients lie on the left decubitus position. Rectal lidocaine gel will be applied 5 min before rectal US probe is introduced. A sonographic examination of the prostate tissue will be performed to check the presence of prominent lesions. Total prostate volumes will be measured. Multiparametric prostate MRI images will be uploaded to the US system on the day of biopsy. After segmentation (matching) of MRI images with sonographic images, the lesions reported in mpMR will be marked. The periprostatic block will be then performed with 2% prilocaine hydrochloride (20 mg/mL) injected into the neurovascular bundle on both sides of the prostate, with 5 mL to the right and 5 mL to the left. Following the block, two to five core biopsies from the MRI-targeted lesions with PIRADS ≥3 will be obtained. All procedures in fusion biopsy will be performed by two urologists experienced and trained in transrectal prostate ultrasonography and biopsy. After the F-TRUS biopsy completed, a standard 12-core TRUS biopsy will performed on fusion group. STRUS_B arm only standard 12 core transrectal prostate biopsy will be performed. A histopathological evaluation of biopsy specimens will be performed by a uro-pathologist with >10 years of experience. The percentage of cancer within the core, primary, and secondary Gleason score and grade according to the 2014 International Society of Urological Pathology (ISUP) grade will be specified in the final pathology report. Patients reported with high-grade prostatic intraepithelial neoplasm in three or more cores or atypical small acinar proliferation will be redirected to rebiopsy, but they will be included to the benign group in the evaluation of the present study.

As the secondary outcomes, pain level during MR fusion biopsy and STRUS biopsy evaluated by visual analogue scale score, cancer detection rates of different core numbers taken form MR targeted lesion, role of the peripheric blood parameters (such as, neutrophil to lymphocyte ratio and systemic immune inflammatuary index) in predicting prostate cancer in PRIADS 3,4 and 5lesions, and comparison of the tumor laterality and ISUP grade in MR US fuison biopsy and radical prostatectomy specimens will be evaluated.

Study Type

Interventional

Enrollment (Actual)

600

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey
      • Kayseri, Turkey, 38039
        • Department of Urology, Ercieys University, Faculty Of Medicine,

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

43 years to 73 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Male

Description

Inclusion Criteria:

PSA level 2,5-10mg/dl Approving the transrectal prostate biopsy and mpMR NO contraindication for MR: glomerular filtration rate (GFR) >60ml/dk, no claustrophobia, no prosthesis or cardiac pacemaker which is not suitable for MR no contraindication for stopping antiaggregant or antithrombotic treatment. no history of previous prostate biopsy no diagnosis of prostate cancer or other malignancies

Exclusion Criteria:

  • not approving the biopsy and MR imaging
  • having prosthesis or cardiac pace maker not suitable for MR
  • having contraindication for stopping antiaggregant or antithrombotic treatment.
  • history of previous prostate biopsy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: fusion arm
Patients in this arm will be undertaken standard transrectal prostate biopsy and MR guided MR-US fusion prostate biopsy
Procedure: mpMR guided MR-US fusion transrectal prostate biopsy
mpMR images will be loaded to US fusion platform and registration of the will be performed. Suspicious lesions on MR which have PIRADS score 3 and above are targeted. Additional 2-4 cores biopsies will be taken them
Other Names:
  • Fusion biopsy
Other: Standard arm
Patients in this arm will be undertaken only standard transrectal prostate biopsy
Procedure: 12 core standard transrectal prostate biopsy
Under the guidance of transrectal ultrasonography, 12 core biopsies taken from apex, apex lateral, mid, mid lateral, base and base lateral of right and left prostate lobe
Other Names:
  • STRUS-B

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
cancer detection rate of MR-US fusion biopsies
Time Frame: 15 days after biopsy
percentage of prostate cancer detected by fusion biopsies
15 days after biopsy
clinically significant cancer detection rate of MR-US fusion biopsies
Time Frame: 15 days after biopsy
percentage of prostate cancer which is ISUP group 2 and above detected by fusion biopsies
15 days after biopsy
cancer detection rate of STRUS-B
Time Frame: 15 days after biopsy
percentage of prostate cancer detected by STRUS-B
15 days after biopsy
clinically significant cancer detection rate of STRUS-B
Time Frame: 15 days after biopsy
percentage of prostate cancer which is ISUP group 2 and above detected by STRUS-B
15 days after biopsy
cancer detection rate of combined method (fusion + STRUS-B )
Time Frame: 15 days after biopsy
percentage of prostate cancer detected by combined method
15 days after biopsy
clinically significant cancer detection rate of combined method (fusion + STRUS-B )
Time Frame: 15 days after biopsy
percentage of prostate cancer which is ISUP group 2 and above detected by combined method
15 days after biopsy

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Visual analogue Scale score for pain
Time Frame: Just after the biopsy
To score the pain level that expreinced by patients during STRUS-B and MR-US bx
Just after the biopsy
Comparison of the cancer detection rate of different core numbers taken from MR lesion.
Time Frame: 15 days after biopsy
Cancer detection rate of the 2, 3 and 4 cores taken from PIRADS 3,4 and 5 lesion
15 days after biopsy
Neutrophil to lymphocyte ratio to predict cancer in different PRIADS lesions.
Time Frame: 15 days after biopsy
Neutrophil to lymphocyte ratio to predict cancer in different PRIADS lesions.
15 days after biopsy
Role of Systemic immune-infllamatuary index to predict the caner in PIRADS 3,4 5 lesions
Time Frame: 15 days after biopsy
neutrophil x platelet count /lymphocyte count
15 days after biopsy
Tumor upgrade rate of MR US fusion biopsy in radical prostatectomy specimens
Time Frame: 15 days after radical prosatetctomy
comparison of the ISUP grade of MR-fusion biopsy and radical prostatectomy speimens at whom underwent radical prostatectomy
15 days after radical prosatetctomy
Tumor laterality in biopsy specimens and radical prostatectomy specimens
Time Frame: 15 days after radical prosatetctomy
Tumor laterality in biopsy specimens and radical prostatectomy specimens
15 days after radical prosatetctomy

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

TC Erciyes University

Investigators

  • Principal Investigator: Abdullah Demritas, Assoc Prof, Erciyes University Faculty of Medicine

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 6, 2017

Primary Completion (Actual)

June 30, 2020

Study Completion (Actual)

August 28, 2020

Study Registration Dates

First Submitted

April 30, 2019

First Submitted That Met QC Criteria

April 30, 2019

First Posted (Actual)

May 3, 2019

Study Record Updates

Last Update Posted (Actual)

September 1, 2020

Last Update Submitted That Met QC Criteria

August 28, 2020

Last Verified

August 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • TSG-2016-5200

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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