Prostate Imaging Using MRI +/- Contrast Enhancement (PRIME)

A Study Comparing Bi-parametric MRI to Multi-parametric MRI in the Diagnosis of Clinically Significant Prostate Cancer

This prospective clinical trial (PRostate Imaging using Mri +/- contrast Enhancement (PRIME)) aims to assess whether biparametric MRI (bpMRI) is non-inferior to multiparametric mpMRI (mpMRI) in the detection of clinically significant prostate cancer.

This means that we are comparing MRI scans that requires injection of IV contrast (the current standard practice) versus MRI scans that can be performed without IV contrast in the detection of prostate cancer.

Study Overview

• Status: Active, not recruiting
• Conditions: Prostate Cancer
• Intervention / Treatment: Diagnostic test: Multiparametric MRI +/- prostate biopsy; Diagnostic test: Biparametric MRI +/- prostate biopsy

Detailed Description

The PRECISION study (NCT02380027) has established that multiparametric MRI +/- targeted biopsy of suspicious areas identified on MRI is superior to standard 12 core TRUS biopsy in the detection of clinically significant prostate cancer (Gleason > 3+ 4) (38% vs 26%), in reducing the detection of clinically insignificant prostate cancer (Gleason 3 + 3) (9% vs 22%) and in maximising the proportion of cores positive for prostate cancer (44% vs 19%).

Multiparametric MRI (mpMRI) typically uses T2-weighted (T2W), diffusion-weighted (DWI) and dynamic contrast enhanced (DCE) sequences. As a mpMRI is a precious resource, due to capacity and resource limitations, one of the major challenges across institutions is delivering a health service with pre-biopsy MRI before a biopsy in all men with suspected prostate cancer.

However, biparametric MRI (bpMRI), that is, a combination of T2W and DWI, which does not use the DCE sequences, has demonstrated similar detection rates of prostate cancer as mpMRI in some studies and there is a debate about the necessity of the DCE sequence.

The potential advantages of avoiding the DCE sequence include avoiding the cost associated with it, shorter scan time, avoiding the need for medical practitioner attendance, and avoiding putative basal ganglia accumulation and the possibility of adverse neurological effect. Thus, a bpMRI approach may be more feasible and have health-economic benefits over a mpMRI approach and may thus increase the accessibility of this resource to men who need it.

PRIME is a multi-centre study. Men referred with clinical suspicion of prostate cancer based on raised prostate specific antigen (PSA) or abnormal digital rectal examination (DRE) who have had no prior biopsy undergo mpMRI. The DCE sequence is blinded from the radiologist who reports the bpMRI first. After reporting the bpMRI, the DCE sequence is made available to the radiologist who reports the mpMRI. The MRIs and lesions are scored on 1-5 scales of suspicion for the likelihood that clinically significant cancer is present:

1. - Very low (clinically significant cancer is highly unlikely to be present)
2. - Low (clinically significant cancer is unlikely to be present)
3. - Intermediate (the presence of clinically significant cancer is equivocal)
4. - High (clinically significant cancer is likely to be present)
5. - Very high (clinically significant cancer is highly likely to be present)

Men with non-suspicious MRI on bpMRI and mpMRI and low clinical risk of prostate cancer will be counselled by their clinical teams as per routine clinical care. In routine clinical practice these men typically do not undergo prostate biopsy.

Suspicious areas scoring 3, 4 or 5 on either bpMRI or mpMRI will undergo targeted and systematic biopsy using the information from the mpMRI to influence biopsy conduct. Suspicious areas will be labelled by their MRI score, with their location according to sector diagrams.

The proportion of patients with clinically significant prostate cancer will be ascertained and compared between bpMRI and mpMRI.

Treatment eligibility decisions without the DCE information will be made and once the clinicians are unblinded to the DCE sequence the impact that this information makes on the treatment decision will be evaluated.

• Study Type: Interventional
• Enrollment (Actual): 500
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Argentina
  • Buenos Aires, Argentina
    • Centro de Urología
• Australia
  • Melbourne, Australia
    • Monash University
  • Melbourne E., Australia
    • Peter MacCallum Cancer Centre
• Belgium
  • Ghent, Belgium
    • Ghent University Hospital
• Brazil
  • São Paulo, Brazil
    • Hospital Sírio-Libanês
• Canada
  • Toronto, Canada
    • Princess Margaret Cancer Centre
• Denmark
  • Copenhagen, Denmark
    • Herlev and Gentofte Hospital
• Finland
  • Helsinki, Finland
    • Helsinki University Hospital
• France
  • Bordeaux, France
    • Bordeaux Pellegrin University Hospital
  • Lille, France
    • Chu Lille
  • Paris, France
    • Sorbonne Université
• Germany
  • Düsseldorf, Germany
    • Heinrich Heine University Düsseldorf
  • Essen, Germany
    • Essen University Hospital
  • Frankfurt, Germany
    • University Hospital Frankfurt
  • Hamburg, Germany
    • Martini Klinik
• Italy
  • Milan, Italy
    • San Raffaele Hospital
  • Rome, Italy
    • Sapienza University
  • Turin, Italy
    • San Giovanni Battista Hospital
  • Udine, Italy
    • University Hospital of Udine
• Netherlands
  • Nijmegen, Netherlands
    • Radboudumc
• Singapore
  • Novena, Singapore
    • Tan Tock Seng Hospital
• Spain
  • Córdoba, Spain
    • Hospital Universitario Reina Sofia
  • Madrid, Spain
    • Hospital Universitario La Moraleja
• United Kingdom
  • Cambridge, United Kingdom
    • Addenbrooke's Hospital
  • London, United Kingdom
    • Royal Free London NHS Foundation Trust
  • London, United Kingdom
    • Whittington Hospital
  • London, United Kingdom
    • University College London and University College London Hospital
• United States
  • Minnesota
    • Rochester, Minnesota, United States, 55905
      • Mayo Clinic
  • New York
    • New York, New York, United States, 10032
      • New York Presbyterian Hospital
    • New York, New York, United States, 10016
      • NYU Langone
    • New York, New York, United States, 10029
      • Icahn School of Medicine (Mount Sinai)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Men at least 18 years of age referred with clinical suspicion of prostate cancer
2. Serum PSA ≤ 20ng/ml
3. Fit to undergo all procedures listed in protocol
4. Able to provide written informed consent

Exclusion Criteria:

1. Prior prostate biopsy
2. Prior treatment for prostate cancer
3. Prior prostate MRI on a previous encounter
4. Contraindication to MRI
5. Contraindication to prostate biopsy
6. Unfit to undergo any procedures listed in protocol

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: mpMRI; Multiparametric MRI	Diagnostic test: Multiparametric MRI +/- prostate biopsy; MRI with T2-weighted, diffusion weighted and dynamic contrast enhanced sequences followed by prostate biopsy if indicated on MRI and clinical findings
Experimental: bpMRI; Biparametric MRI	Diagnostic test: Biparametric MRI +/- prostate biopsy; MRI with T2-weighted and diffusion weighted sequences followed by prostate biopsy if indicated on MRI and clinical findings

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Proportion of men with clinically significant cancer	When biopsy results available, at an expected average of 30 days post-biopsy

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of men with clinically insignificant cancer (Gleason grade 3+3 / Gleason grade group 1)		When biopsy results available, at an expected average of 30 days post-biopsy
Agreement between bpMRI and mpMRI for score of suspicion	Score of suspicion on MRI (1-5) - lowest score = 1 = highly unlikely to be significant cancer. Highest score = 5 = highly likely to be significant cancer. For MRI to be non-suspicious it needs to be scored 1 or 2 on both Likert and PIRADSv2.1 systems. For MRI to be suspicious it can to be scored 3, 4 or 5 on either Likert or PIRADSv2.1 systems.	When MRI results available, at an expected average of 30 days post-MRI
Agreement between bpMRI and mpMRI for radiological staging decision		When MRI results available, at an expected average of 30 days post-MRI
Agreement between bpMRI and mpMRI for treatment eligibility	At the coordinating centre, in a multi-disciplinary team meeting, treatment eligibility decisions without the DCE information will be made and once the clinicians are unblinded to the DCE sequence the impact that this information makes on the treatment decision will be evaluated.	When treatment options discussed in multidisciplinary meeting, at an expected average of 30 days post intervention
Test performance characteristics for bpMRI & mpMRI when using the Likert scoring system in comparison to the PIRADS scoring system		When biopsy results available, at an expected average of 30 days post-MRI
Proportion of men with cancer missed by bpMRI and mpMRI-targeted biopsies and detected by systematic biopsy		When biopsy results available, at an expected average of 30 days post-biopsy
Cost-effectiveness of BpMRI compared to mpMRI (cost per diagnosis of prostate cancer)	A within-trial analysis will be conducted to calculate the total cost for bpMRI and mpMRI and mean cost per patient if a strategy of bpMRI or mpMRI were adopted. The cost per diagnosis of clinically significant cancer will be calculated for bpMRI and mpMRI. An incremental cost effectiveness ratio may be calculated by deriving the additional cost per case of clinically significant cancer diagnosed. The cost of avoiding each additional case of clinically insignificant cancer diagnosed may also be calculated. Consideration will be given to extending this analysis using economic modelling to allow a lifetime perspective to be taken and the estimation of quality adjusted life years (QALYs). Costs of procedures will be estimated by multiplying standard unit costs by key resource using data captured within the trial. If possible, standard unit costs (e.g. NHS Reference costs) will be supplemented by unit cost data (and uncertainty around these costs) from the participating trial sites.	At an expected average of 30 days post-intervention

Collaborators and Investigators

• Sponsor: University College, London
• Investigators: Study Chair: Veeru Kasivisvanathan, MBBS PhD, University College, London; Principal Investigator: Caroline Moore, MD FRCS, University College, London; Principal Investigator: Mark Emberton, MD FRCS, University College, London; Principal Investigator: Clare Allen, FRCR, University College London Hospital; Principal Investigator: Shonit Punwani, PhD FRCR, University College, London; Principal Investigator: Francesco Giganti, MD, University College, London

Publications and helpful links

Helpful Links

• PRIME Study, UCL

Study record dates

Study Major Dates

• Study Start (Actual): March 22, 2022
• Primary Completion (Estimated): December 1, 2024
• Study Completion (Estimated): March 1, 2025

Study Registration Dates

• First Submitted: September 9, 2020
• First Submitted That Met QC Criteria: September 25, 2020
• First Posted (Actual): October 1, 2020

Study Record Updates

• Last Update Posted (Actual): September 23, 2024
• Last Update Submitted That Met QC Criteria: September 19, 2024
• Last Verified: September 1, 2024

More Information

Terms related to this study

• Keywords: diagnosis; targeted; mri; biopsy; multiparametric; biparametric
• Additional Relevant MeSH Terms: Neoplasms; Urogenital Neoplasms; Neoplasms by Site; Genital Neoplasms, Male; Prostatic Diseases; Urogenital Diseases; Male Urogenital Diseases; Genital Diseases, Male; Genital Diseases; Prostatic Neoplasms
• Other Study ID Numbers: 135819

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Anonymised data will be available at request for bona fide researchers with important research questions subject to approval by the study steering committee.
• IPD Sharing Time Frame: Data will become available 1 year after publication of the main study results.
• IPD Sharing Access Criteria: A study steering committee will review all requests for access to the data and will make decisions on whether or not to grant access to bona fide researchers based on the importance of the research question being asked, ensuring analysis is non overlapping with existing analyses and planned analyses.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes