Prostate Cancer Clinical Trial
— CLIMATEOfficial title:
A Comparison of the Diagnostic Accuracy of Luminal Index Magnetic Resonance Imaging and Multi-parametric Magnetic Resonance Imaging for the Accelerated Detection of Significant Prostate Cancer
NCT number | NCT05020522 |
Other study ID # | 281621 |
Secondary ID | |
Status | Recruiting |
Phase | N/A |
First received | |
Last updated | |
Start date | May 1, 2022 |
Est. completion date | March 1, 2025 |
Multi-parametric (mp) MRI has now internationally been incorporated as standard of care in the work-up of participants with suspected prostate cancer. The standard mpMRI protocol requires 30-45 minutes to be performed and has a sensitivity and specificity of approximately 90% and 50% for the detection of clinically significant prostate cancer. Compared to the non-targeted systematic transrectal ultrasound (TRUS) biopsy approach in men with clinically suspected prostate cancer (e.g.: elevated PSA), performing mpMRI as a triage test allows to detect clinically significant cancer in more men (38% vs 26%) and clinically insignificant cancer in less men (9% vs 22%), while avoiding biopsy in roughly one third of men. However, there is need for improvement in the prostate diagnostic pathway even after incorporation of mp-MRI, specifically mpMRI can miss significant cancer in around 10% of cases and only 50% of positive scans turn out to harbor significant cancer at biopsy. Moreover, the key functional imaging sequence of mp-MRI (i.e.: DWI) often suffers from image artifacts causing difficulty in scan interpretation. To address these issues the investigators aim to investigate Luminal Index MRI (LI-MRI), a novel method of MR imaging that requires only up to 10 minutes to be performed and doesn't require the use of contrast media. LI-MRI has shown promising results for the characterization of prostate cancer. In this study the diagnostic performance of LI-MRI and mpMRI for the detection of prostate cancer will be directly compared.
Status | Recruiting |
Enrollment | 702 |
Est. completion date | March 1, 2025 |
Est. primary completion date | March 1, 2024 |
Accepts healthy volunteers | No |
Gender | Male |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Men with clinically suspected prostate cancer and referred for prostate MRI - Willing and able to provide a written informed consent Exclusion Criteria: - Prostate specific antigen (PSA) level > 20ng/ml within 6 months - Previous diagnosis of prostate cancer - Ongoing hormone treatment within 3 months prior to MRI, excluding antiandrogens or 5-alpha reductase inhibitors - Contraindication to MRI scan - Contraindication to administration of gadolinium-based contrast agents |
Country | Name | City | State |
---|---|---|---|
United Kingdom | University College London Hospitals NHS Foundation Trust | London |
Lead Sponsor | Collaborator |
---|---|
University College, London |
United Kingdom,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | ctMethSig and risk of metastases | Correlation of ctMethSig with other clinical factors known to be associated with risk of metastasis (e.g. Gleason grade) | 3 years | |
Primary | Diagnostic accuracy of mp-MRI and LI-MRI | Comparison of per-participant diagnostic accuracy of mp-MRI and LI-MRI for the detection of clinically significant prostate cancer (i.e. Gleason 3+4 or higher). Two endpoints are included in the primary outcome: difference in sensitivity and difference in specificity. | 3 years | |
Secondary | Diagnostic accuracy of LI-MRI as an add-on test | Per-participant diagnostic accuracy of LI-MRI as an add-on test in combination with mp-MRI for the detection of clinically significant cancer. | 3 years | |
Secondary | Proportion of correct clinical recommendation | Comparison of the proportion of men who would receive a correct clinical recommendation that biopsy could be avoided using mp-MRI and LI-MRI by retrospective analysis. | 3 years | |
Secondary | Per-lesion diagnostic accuracy of mp-MRI and LI-MRI | Comparison of per-lesion diagnostic accuracy of LI-MRI and mp-MRI for clinically significant cancer (difference in sensitivity and specificity). | 3 years | |
Secondary | Proportion of non-significant cancer detection | Comparison of the proportion of men diagnosed with non-significant cancer (Gleason 3+3) based on LI-MRI and mp-MRI targeted biopsies. | 3 years | |
Secondary | Value of MRI in diagnostic models | Evaluation of the added value of MRI when included in a diagnostic model of clinically significant cancer based on the clinical features of age and PSA density. | 3 years | |
Secondary | Luminal Index quantitative analysis | Correlation between Luminal Index quantitative metric and tumor Gleason grade | 3 years | |
Secondary | Interobserver agreement on LI-MRI scores | Interobserver agreement among radiologists on LI-MRI scores. | 3 years | |
Secondary | Interobserver agreement on Gleason scores | Interobserver agreement among histopathologists on Gleason scores at biopsy. | 3 years | |
Secondary | ctMethSig true positive rate | Proportion of men with clinically significant cancer who are positive with ctMethSig. | 3 years | |
Secondary | ctMethSig false positive rate | Proportion of men without clinically significant cancer who are positive with ctMethSig. | 3 years |
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