Imaging for Significant Prostate Cancer Risk Evaluation (PICTURE)
The incidence of prostate cancer is rising however the number of deaths from prostate cancer is stable. Meaning the investigators are diagnosing many men with prostate cancer that will not impact on their life. The rise in incidence is mainly due to increased use of the blood test Prostate Specific Antigen (PSA), as a screening test.
Currently men suspected of having prostate cancer, identified by a raised PSA undergo trans-rectal ultrasound guided prostate biopsy (TRUS biopsy). Many men have this test unnecessarily, only 1/3 being diagnosed with prostate cancer. TRUS biopsy is problematic as it is random and performed blind-the operator does not know where the cancer is. Thus many low-risk cancers that do not need treating are diagnosed and many high risk cancers are missed or incorrectly classified. So, men with a negative biopsy or those with low risk disease are usually advised to undergo another TRUS biopsy.
An imaging test is needed that could help men and their doctors decide whether the biopsy is a true reflection of what is inside his prostate.
The investigators will test the role of two imaging tests. The first, multi-parametric magnetic resonance imaging (mp-MRI) uses magnetic signals from the body to form images. The second, Prostate HistoScanning™ (PHS) uses sound-waves. The investigators will compare the results of these tests with a detailed biopsy map-transperineal template prostate mapping biopsy (which is currently the best way to find out what is in the prostate but requires multiple biopsies to be taken under general anaesthetic. Eligible men will have undergone one or more TRUS biopsies and who have been advised to have further tests on as part of standard of care. They will be recruited from UCLH referral letters and clinics.
The investigators aim is to see if either of these tests can confidently rule out the presence of clinically important disease.
Procedure: Prostate HistoScanning
Procedure: Multi-parametric MRI
Procedure: Transperineal prostate mapping biopsy
Procedure: Image guided biopsies
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Diagnostic
|Official Title:||PICTURE - Prostate Imaging (Multi-parametric MRI and Prostate HistoScanning™) Compared to Transperineal Ultrasound Guided Biopsy for Significant Prostate Cancer Risk Evaluation.|
- Number of men who could avoid repeat biopsy as determined by the Negative predictive value and specificity of mp-MRI for Clinically significant disease. [ Time Frame: 18 months ] [ Designated as safety issue: No ]Performance characteristics of mp-MRI for ruling out CLINICALLY SIGNIFICANT prostate cancer as determined by negative predictive value and specificity
- Number of men who could avoid repeat biopsy as determined by the negative predictive value and specificity of Prostate HistoScanning for Clinically significant disease. [ Time Frame: 18 months ] [ Designated as safety issue: No ]Performance characteristics of Prostate HistoScanning for ruling out CLINICALLY SIGNIFICANT prostate cancer as determined by negative predictive value and specificity
- Proportion of men correctly identified as having no cancer on Imaging (mp-MRI and Prostate HistoScanning) [ Time Frame: 18 months ] [ Designated as safety issue: No ]Negative predictive value of Imaging compared to Transperineal template Mapping prostate biopsy.
- Number of men correctly identified by Imaging (mp-MRI and Prostate HistoScanning) to have CLINICALLY SIGNIFICANT disease [ Time Frame: 18 months ] [ Designated as safety issue: No ]Number of men correctly identified by each test to have clinically significant disease as detected by Transperineal Template Mapping Biopsy
- Test- retest reproducibility of Prostate HistoScanning™. [ Time Frame: 18 months ] [ Designated as safety issue: No ]The reproducibility of Prostate HistoScanning will be assessed by looking at the predicted cancer volume and location of the HistoScanning investigation at two time points.
- Proportion of patients with correct disease risk stratification using MRI/US guided biopsies as determined by sensitivity and specificity [ Time Frame: 18 months ] [ Designated as safety issue: No ]Performance characteristics of MRI/US registration targeted biopsies compared to i) systematic biopsies and ii) cognitive targeted biopsies in prostate cancer risk stratification as determined by sensitivity and specificity
- Number of patients with bothersome Lower Urinary tract symptoms following Transperineal Template Mapping biopsy [ Time Frame: 18 months ] [ Designated as safety issue: Yes ]
Assessment of alterations in Lower Urinary tract function following Transperineal Template Mapping Biopsy
IPSS, IPSS-QoL, Continence Function Questionnaire.
- Number of patients with worsened erectile function compared to baseline following Transperineal Template Mapping biopsy [ Time Frame: 18 months ] [ Designated as safety issue: Yes ]
Assesment of erectile function compared to baseline will be made using questionnairres.
|Study Start Date:||December 2011|
|Estimated Study Completion Date:||July 2013|
|Estimated Primary Completion Date:||July 2013 (Final data collection date for primary outcome measure)|
Procedure: Prostate HistoScanning
|Contact: Lucy AM Simmons, MBBS||0044 (0) 207 679 email@example.com|
|University College London Hospitals||Recruiting|
|London, United Kingdom, NW1 2PG|
|Contact: Lucy AM Simmons, MBBS, MRCS 0044 203 447 9194 firstname.lastname@example.org|
|Contact: Hashim Uddin Ahmed, MBBS, MRCS 0044 203 447 9194|
|Sub-Investigator: Hashim Uddin Ahmed, MBBS, MRCS|
|Sub-Investigator: Caroline M Moore, MBBS,MD,FRCS|
|Principal Investigator:||Mark Emberton, MBBS,MD,FRCS||University College London Hospitals|