Imperial Prostate 7 - Prostate Assessment Using Comparative Interventions - Fast Mri and Image-fusion for Cancer (IP7-PACIFIC)

Evaluating the Role of Biparametric MRI and Image-fusion Targeted Biopsies for Detection of Prostate Cancer

To evaluate the role of biparametric MRI and image-fusion targeted biopsies for the detection of prostate cancer.

To determine whether biparametric MRI (bpMRI) could be recommended as an alternative to multiparametric MRI (mpMRI) for the detection of clinically significant prostate cancers in patients at risk.

To determine whether image-fusion targeted biopsy is better than visual-registration (cognitive) targeted biopsy at detecting clinically significant prostate cancers in patients requiring prostate biopsy due to a suspicious MRI.

Study Overview

• Status: Recruiting
• Conditions: Neoplasms; Adenocarcinoma; Prostatic Neoplasms; Prostatic Diseases; Prostate Cancer
• Intervention / Treatment: Diagnostic test: bpMRI; Diagnostic test: Image-Fusion targeted and systematic Biopsy

Detailed Description

Background and study aims:

The aim of this study is to improve the way prostate cancer is diagnosed by looking at two different types of MRI scans and two different types of prostate biopsy (tissue samples). A large study such as this is required to help the NHS decide how to diagnose prostate cancer in the future. If a person is suspected of having prostate cancer, then they are referred by their GP. At the hospital clinic, the participant will then have an MRI scan. If this scan shows that cancer might be present, then the doctor will usually suggest that the patient has a biopsy. There are two ways of doing a prostate MRI. One takes 30-40 minutes and requires a contrast injection called gadolinium (like a dye). This is called long MRI and is most commonly used in the NHS. Gadolinium is safe as it rarely causes any bad reaction but using it means that the scan takes more time. Another type of MRI takes 15-20 minutes and does not use gadolinium contrast. This is called a short MRI. Many studies over the last 5 years have shown that the long and short MRIs are similar in their accuracy in diagnosing important prostate cancer. These studies have not been of high quality or large enough to change NHS practice. Patients with suspicious areas on the MRI are usually advised to have a prostate biopsy. This involves taking tissue samples using a needle. The samples are then looked at under the microscope by a pathologist to see if cancer cells are present. There are two ways of doing a prostate biopsy. One is where the person doing the biopsy decides where to put the biopsy needle by looking at the MRI scans that have been already taken on a computer screen. The needle is guided to the prostate using live ultrasound scans that are shown on a different screen near the patient. The biopsy operator makes a judgement about where to place the biopsy needles. This is called visual registration. Tissue samples from other areas of the prostate that look normal on the MRI scans are also taken to ensure cancer is not missed. The other type of biopsy is called image fusion. During image fusion biopsy, the biopsy operator uses the MRI scans that have been taken beforehand but laid on top of the live ultrasound images during the biopsy. This uses software and takes a few minutes longer to perform. Once the MRI images and ultrasound images are 'fused', the actual biopsies are taken as normal. Studies over the last 5 years have shown mixed results. Some have shown that image fusion biopsy is no better than visual registration biopsy, whilst a few have shown it might make a difference in improving cancer detection. As a result, it is not known for certain which way is better. A large study is needed to show whether the investigators need to do image fusion or not, in order for the NHS to decide whether or not to use it in all hospitals doing prostate biopsies.

• Study Type: Interventional
• Enrollment (Estimated): 3600
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Hashim Ahmed; Phone Number: 0203 311 1673; Email: hashim.ahmed@imperial.ac.uk
• Study Contact Backup: Name: Thiagarajah Sasikaran; Phone Number: 0207 594 6017; Email: t.sasikaran@imperial.ac.uk

Study Locations

• United Kingdom
  • Basingstoke, United Kingdom, RG24 9NA
    • Recruiting
    • Basingstoke Hospital
    • Principal Investigator: Richard Hindley
    • Contact: Judith Radmore; Phone Number: 44115 01256 473202; Email: judith.radmore@hhft.nhs.uk
  • Bristol, United Kingdom, BS10 5NB
    • Recruiting
    • Southmead Hospital
    • Contact: Rebecca Cousins; Phone Number: 0117 4148109; Email: urologyresearch@nbt.nhs.uk
    • Principal Investigator: Jonathan Aning
  • Cambridge, United Kingdom
    • Recruiting
    • Addenbrooke Hospital, Cambridge
    • Principal Investigator: Tristan Barrett
  • Carlisle, United Kingdom, CA2 7HY
    • Recruiting
    • Cumberland Infirmary
    • Contact: Bev Wilkinson; Phone Number: 01228 814397; Email: beverley.wilkinson@ncic.nhs.uk
    • Contact: Rachel Mutch; Phone Number: 01946523410; Email: rachel.mutch@ncic.nhs.uk
    • Principal Investigator: Kathie Wong
  • Chertsey, United Kingdom
    • Recruiting
    • St Peters Hospital
    • Principal Investigator: Nimalan Arumainayagam
  • Dartford, United Kingdom, DA2 8DA
    • Recruiting
    • Darent Valley Hospital
    • Contact: Carmel Stuart; Phone Number: 4323 01322 428100; Email: carmel.stuart@nhs.net
    • Principal Investigator: Sanjeev Madaan
  • Harrow, United Kingdom
    • Recruiting
    • Northwick Park Hospital
    • Principal Investigator: Gaurav Mukerji
  • Leeds, United Kingdom
    • Recruiting
    • St James's Hospital, Leeds
    • Principal Investigator: Oliver Hulson
  • London, United Kingdom, W6 8RF
    • Recruiting
    • Charing Cross Hospial
    • Contact: Francesca Rawlins; Email: f.rawlins@imperial.ac.uk
    • Principal Investigator: Hashim Ahmed, FRCS
  • Manchester, United Kingdom
    • Recruiting
    • Manchester Royal Infirmary
    • Contact: Charlene Hyde; Email: charlene.hyde@mft.nhs.uk
    • Principal Investigator: Amar Mr Mohee
  • Northampton, United Kingdom
    • Recruiting
    • Northampton General Hospital
    • Principal Investigator: Aakash Pai
  • Uxbridge, United Kingdom, UB8 3NN
    • Recruiting
    • Hillingdon Hospital
    • Contact: Mariam Nasseri; Phone Number: 01895 279021; Email: mariam.nasseri1@nhs.net
    • Principal Investigator: Saheel Mukhtar
  • Essex
    • Southend-on-Sea, Essex, United Kingdom, SS0 0RY
      • Recruiting
      • Southend University Hospital
      • Contact: Lesley Nichols, FRCS; Phone Number: 6411 01702 435555; Email: lesley.nichols1@nhs.net
      • Principal Investigator: Peter Archer
  • Hampshire
    • Southampton, Hampshire, United Kingdom, SO16 6YD
      • Recruiting
      • University Hospital Southampton
      • Contact: Aneta Zahorska; Phone Number: 023 8120 3560; Email: aneta.zahorska@uhs.nhs.uk
      • Contact: Nikki Carney; Phone Number: 023 8120 3560; Email: nikki.carney@uhs.nhs.uk
      • Principal Investigator: Chedgy Edmund
  • Kent
    • Gillingham, Kent, United Kingdom, ME7 5NY
      • Not yet recruiting
      • Medway Maritime Hospital
      • Contact: Mandeep Badyal; Phone Number: 6513 01634 976513; Email: Mandeep.badyal@nhs.net
      • Principal Investigator: Shikohe Masood

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Randomisation 1

Inclusion Criteria:

• Age 18 years or above (no upper limit)
• Patients with a prostate (either cis-male gender or trans-female gender with no prior androgen deprivation hormone use at all).
• Referred to hospital and advised to undergo a prostate MRI because of an abnormal digital rectal examination (regardless of PSA level) and/or an elevated PSA (within 6 months of screening visit) PSA >/=3.0ng/ml for age 50-69 years PSA >/=5.0ng/ml for age >/=70 years If family or ethnic risk for prostate cancer, PSA >/=2.5ng/ml for age 45-49 years

Exclusion Criteria:

• PSA >50ng/ml
• Prior prostate MRI or prostate biopsy in the two years prior to screening visit
• Prior diagnosis of prostate cancer
• Contraindication to MRI or gadolinium contrast
• Previous hip replacement to both hips
• Contraindication to performing a biopsy guided by a transrectal ultrasound probe

Randomisation 2

Inclusion Criteria:

• Visible suspicious finding on mpMRI or bpMRI from randomisation 1 requiring a targeted biopsy (MRI score 3, 4, 5 on either Likert or PIRADS schema)

Exclusion Criteria:

• As above for randomisation 1
• Patient refusal for biopsy

Study Plan

How is the study designed?

Design Details

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

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Standard: mpMRI; Participants will undergo mpMRI. Blinding will not be possible. Once the MRI report is issued, the local clinical team will make a decision about advising whether a biopsy is necessary or not.
Active Comparator: Intervention 1: bpMRI; Participants will undergo bpMRI. Blinding will not be possible. Once the MRI report is issued, the local clinical team will make a decision about advising whether a biopsy is necessary or not.	Diagnostic test: bpMRI; biparametric MRI takes 30-40 minutes and requires a contrast injection called gadolinium (like a dye). This is also called long MRI and is most commonly used in the NHS.; Other Names: biparametric MRI
No Intervention: Standard: Visual estimation targeted and systematic biopsy; Randomisation 2 will only be relevant if participants are advised by their clinical team to have a biopsy based on their MRI and other clinical factors. Participants advised to have a biopsy will undergo a visual estimation targeted biopsy
Active Comparator: Intervention 2: Image-fusion targeted and systematic biopsy; Randomisation 2 will only be relevant if participants are advised by their clinical team to have a biopsy based on their MRI and other clinical factors. Participants advised to have a biopsy will undergo an image fusion targeted biopsy.	Diagnostic test: Image-Fusion targeted and systematic Biopsy; During image fusion targeted biopsy, the biopsy operator uses the MRI scans that were taken beforehand but laid on top of the live ultrasound images during the biopsy. This uses software and takes a few minutes longer to perform. Once the MRI images and ultrasound images are 'fused', the actual biopsies are taken as normal.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Randomisation 1: Proportion of clinically significant cancers detected in the randomised population of patients at risk.	Proportion of clinically significant cancers, defined as any amount of Gleason ≥3+4 (ISUP Grade Group ≥2) on biopsy, detected in the randomised population of patients at risk.	maximum 12 weeks following enrolment
Randomisation 2: Proportion of clinically significant cancers detected in the randomised population of patients biopsied for a suspicious MRI.	Proportion of clinically significant cancers, defined as any amount of Gleason ≥3+4 (ISUP Grade Group ≥2) on biopsy, detected in the randomised population of patients biopsied for a suspicious MRI.	maximum 12 weeks following enrolment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
MRI related adverse events	MRI related adverse events measured using documentation	maximum 12 weeks following enrolment
MRI related serious adverse events	MRI related serious adverse events measured using documentation	maximum 12 weeks following enrolment
Biopsy related adverse events	biopsy-related adverse events measured using documentation	maximum 12 weeks following enrolment
Biopsy related serious adverse events	biopsy-related serious adverse events measured using documentation	maximum 12 weeks following enrolment
The proportion of patients advised to undergo a needle biopsy after MRI	The proportion of patients advised to undergo a needle biopsy. The researchers will document common reasons for patients who are advised to undergo a biopsy or advised against a needle biopsy and still choose to have a biopsy.	maximum 12 weeks following enrolment
The proportion of patients advised to undergo a prostrate biopsy after MRI	The proportion of patients undergoing a prostate biopsy after MRI. The researchers will document common reasons for patients who are advised to undergo prostrate biopsy after MRI.	maximum 12 weeks following enrolment
The proportion of patients diagnosed with clinically significant prostates cancers on needle biopsy	The proportion of patients diagnosed with clinically significant prostates cancers defined as any Gleason 3+3=6 on needle biopsy carried out after MRI.	maximum 12 weeks following enrolment
The proportion of patients diagnosed with clinically significant prostate cancers on prostate biopsy carried out after MRI	The proportion of patients diagnosed with clinically significant prostate cancers using other histological thresholds on prostate biopsy carried out after MRI. The researchers will evaluate these proportions by MRI score at patient and lesion level (on a scale of 1 to 5) and by the presence or absence of clinical risk parameters.	maximum 12 weeks following enrolment
The proportion of patients diagnosed with clinically significant prostate cancers with targeted biopsy using four targeted cores	The proportion of patients diagnosed with clinically significant prostate cancers using all histological thresholds on targeted biopsy using four targeted cores	maximum 12 weeks following enrolment
The proportion of patients diagnosed with clinically significant prostate cancers with targeted biopsy using six targeted cores	The proportion of patients diagnosed with clinically significant prostate cancers using all histological thresholds on targeted biopsy using six targeted cores	maximum 12 weeks following enrolment
Detection rates for each randomised group of known prognostic risk categories	Detection rates for each randomised group of known prognostic risk categories. These are D' Amico, National Comprehensive Cancer Network (NCCN) and Cambridge Prognostic Groups (CPG).	maximum 12 weeks following enrolment
Use Likert MRI scoring system to analyse the proportion of patients biopsied	A comparison of the two MRI scoring systems, Likert and PIRADS (the latest version as defined in MRI Reporting SOP), in terms of the proportion of patients biopsied and subsequently diagnosed with clinically significant and clinically insignificant prostate cancer, using each of the histological thresholds, on a prostate biopsy.	maximum 12 weeks following enrolment
Use Prostate Imaging Reporting and Data System (PIRADS) MRI scoring system to analyse the proportion of patients biopsied	A comparison of the two MRI scoring systems, Likert and PIRADS (the latest version as defined in MRI Reporting SOP), in terms of the proportion of patients biopsied and subsequently diagnosed with clinically significant and clinically insignificant prostate cancer, using each of the histological thresholds, on a prostate biopsy.	maximum 12 weeks following enrolment
Characteristics of cancer in targeted systematic biopsies	Characteristics of cancer in targeted versus systematic biopsies by MRI score, PSA, PSA density, age, ethnicity, family history and history of prior prostate biopsy with a multivariable evaluation to determine whether patients might avoid systematic sampling in the future.	maximum 12 weeks following enrolment
Characteristics of cancer in targeted biopsies	Characteristics of cancer in targeted versus systematic biopsies by MRI score, PSA, PSA density, age, ethnicity, family history and history of prior prostate biopsy with a multivariable evaluation to determine whether patients might avoid systematic sampling in the future.	maximum 12 weeks following enrolment
External validation of the Imperial Rapid Access to Prostate Imaging and Diagnosis (RAPID) Risk Score (MRI+)	External validation of the Imperial RAPID Risk Score (MRI+) within each randomised group of the IP7-PACIFIC study, external validation	maximum 12 weeks following enrolment
External validation of the Imperial Rapid Access to Prostate Imaging and Diagnosis (RAPID) Risk Score in (Systematic+)	External validation of Imperial Rapid Access to Prostate Imaging and Diagnosis(RAPID) Risk Score (Systematic+) within each randomised group of the IP7-PACIFIC study, external validation	maximum 12 weeks following enrolment
Impact of prostate biopsy in first randomised group (bpMRI) on patient-reported outcomes	Impact of prostate biopsy in each randomised group on patient-reported outcomes using a survey that includes EQ-5D-5L health-related quality of life questionnaire	maximum 12 weeks following enrolment
Impact of prostate biopsy in second randomised group (mpMRI)on patient-reported outcomes	Impact of prostate biopsy in each randomised group on patient-reported outcomes using a survey that includes EQ-5D-5L health-related quality of life questionnaire	maximum 12 weeks following enrolment
Impact of prostate biopsy in first randomised group (bpMRI) on patient-reported experience measures	Impact of prostate biopsy in each randomised group on patient-reported experience measures using version of the Prospective cohort study (Prostate Biopsy Effects: ProBE) questionnaire.	maximum 12 weeks following enrolment
Impact of prostate biopsy in second randomised group (mpMRI) on patient-reported experience measures	Impact of prostate biopsy in each randomised group on patient-reported experience measures using version of the Prospective cohort study (Prostate Biopsy Effects: ProBE) questionnaire.	maximum 12 weeks following enrolment
Analysis of biopsy rate in cancer detection (by all histological thresholds) during the time of study	Analysis of biopsy rates in cancer detection (by all histological thresholds) in the randomised group will be conducted by centre using centre size. MRI scanner type (1.5 Tesla vs. 3.0 Tesla), type of biopsy route used (transrectal vs trans perineal), number of systematic biopsies taken (limited systematic vs extended systematic biopsy), type of analgesia/anaesthetic (local anaesthetic, sedation or general anaesthetic) as additional stratification factors	maximum 12 weeks following enrolment

Collaborators and Investigators

• Sponsor: Imperial College London
• Collaborators: Cancer Research UK; National Institute for Health Research, United Kingdom

Study record dates

Study Major Dates

• Study Start (Actual): November 2, 2022
• Primary Completion (Estimated): October 31, 2025
• Study Completion (Estimated): January 31, 2026

Study Registration Dates

• First Submitted: August 3, 2022
• First Submitted That Met QC Criteria: October 7, 2022
• First Posted (Actual): October 10, 2022

Study Record Updates

• Last Update Posted (Actual): July 24, 2025
• Last Update Submitted That Met QC Criteria: July 21, 2025
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Keywords: Prostate Cancer; Prostate-Specific Antigen; Prostate biopsy; bpMRI; mpMRI; Multi-parametric MRI; Biparametric MRI
• Additional Relevant MeSH Terms: Urogenital Diseases; Genital Diseases; Genital Neoplasms, Male; Urogenital Neoplasms; Neoplasms by Site; Genital Diseases, Male; Male Urogenital Diseases; Neoplasms; Prostatic Neoplasms; Prostatic Diseases
• Other Study ID Numbers: 22CX7488

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