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MRI Based Active Selection for Treatment Trial (MAST)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT02242773
Recruitment Status : Active, not recruiting
First Posted : September 17, 2014
Last Update Posted : September 16, 2022
National Institutes of Health (NIH)
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Sanoj Punnen, MD, MAS, University of Miami

Brief Summary:
The main purpose of this study is to determine if Magnetic Resonance Imaging (MRI), along with MRI targeted biopsy of suspicious lesions, is of value in detecting patients who would be likely to require treatment earlier.

Condition or disease Intervention/treatment Phase
Prostate Cancer Device: Multi-Parametric MRI Device: MRI-Guided Biopsy Not Applicable

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 207 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: MRI-Guided Active Selection for Treatment of Prostate Cancer: The Miami MAST Trial
Actual Study Start Date : November 12, 2014
Estimated Primary Completion Date : July 2023
Estimated Study Completion Date : July 2024

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Active Surveillance
Participants in this group will receive a Multi-Parametric Magnetic Resonance Imaging (MP-MRI) of the prostate/pelvis and MRI-guided prostate biopsy at baseline (0-3 months from enrollment) and at the 12th, 24th and 36th month follow up.
Device: Multi-Parametric MRI
Multi-Parametric MRI

Device: MRI-Guided Biopsy
MRI-Guided Biopsy

Primary Outcome Measures :
  1. Rate of Disease Progression within the first two surveillance biopsies [ Time Frame: 24 months ]

    To determine if multiparametric MRI and MRI-US fusion biopsies increase the rate of progression (conversion to treatment) within the first two non-diagnostic biopsies after undergoing active surveillance as compared to historical cohorts using standard ultrasound guided biopsies.

    Progression refers to a repeat surveillance biopsy indicating any one of the following:

    1. More than 4 positive cores involving any grade of cancer,
    2. At least two core with Gleason 3+4 cancer,
    3. Any single core with Gleason 4+3 cancer or higher,
    4. A Gleason 3+3 at diagnosis that is upgraded to Gleason 3+4, or
    5. Undergoing treatment, regardless of histological progression.

Secondary Outcome Measures :
  1. Time-to-Biochemical Recurrence [ Time Frame: Up to 36 months ]
    The investigators will use recurrence after primary therapy to identify whether earlier identification of progression with MRI and MRI-US fusion biopsy will portend less recurrence compared to historical patients undergoing delayed primary surgery or radiation after initial surveillance. Biochemical recurrence (BCR) is defined as PSA of 0.2 or higher on two or more separate measures after surgery or an increase of nadir + 2ng/ml or more after radiation. Time-to-BCR is defined as duration between date of treatment and date of BCR if BCR occurs. The investigators will follow participants who have progressed and gone on to treatment.

  2. Health-Related Quality of Life Scores: EPIC SF-12 [ Time Frame: Up to 36 months ]
    Health-Related Quality of Life will be assessed using scores from validated questionnaires. The Expanded Prostate Cancer Index Composite and Medical Outcomes Study SF-12 (EPIC SF-12) will be used to evaluate patient function and satisfaction after prostate cancer treatment. Response options for each item form a Likert scale, and multi-item scale scores are transformed linearly to a 0-100 scale, with higher scores representing better HRQOL.

  3. Health-Related Quality of Life Scores: MAX-PC [ Time Frame: Up to 36 months ]
    Health-Related Quality of Life will be assessed using scores from validated questionnaires. The Memorial Anxiety Scale for Prostate Cancer (MAX-PC) will be used to measure anxiety from pre-treatment to post-treatment. The scale consists of 18 items (e.g. "I thought about prostate cancer even though I didn't mean to.") scored on a scale from 0 ("not at all") to 3 ("often"). Total scores range from 0 to 54, with higher scores indicating higher levels of anxiety.

  4. Area under Receiver Operating Characteristic (ROC) curve [ Time Frame: Up to 36 months ]
    The investigators will assess the incremental benefit of mpMRI, genomic risk test, and molecular markers compared to baseline NCCN risk classification for predicting progression on active surveillance. Area under the receiver operating characteristic Curve (ROC) curve will be used to evaluate the performance of NCCN risk and other variables (MRI, genomic testing, and molecular markers) for predicting progression on surveillance. Participants will be categorized at baseline by NCCN risk class ranging from very low risk to intermediate risk; and into those who progressed while on the trial.

Information from the National Library of Medicine

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Ages Eligible for Study:   35 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Biopsy confirmed adenocarcinoma of the prostate within 18 months prior to enrollment;
  2. Pre-enrollment prostate biopsy must consist of at least 8 cores;
  3. Biopsy reviewed by a University of Miami Pathologist;
  4. Serum Prostate-Specific Antigen (PSA) ≤ 20 ng/ml within 3 months of study enrollment;
  5. Age ≥ 35 and ≤ 85 years;
  6. Ability to understand and willingness to sign a written informed consent document;
  7. Patients must agree to undergo serial multiparametric MRI and MRI-guided biopsy;
  8. Patients must agree to fill out the longitudinal psychosocial questionnaires assessing health related quality of life.

Exclusion Criteria:

  1. Greater than 4 cores positive, of any Gleason score, on the University of Miami (UM) review,
  2. Greater than 2 cores positive for Gleason 3+4 cancer,
  3. Gleason 4+3 or higher cancer in any single biopsy core.
  4. Extracapsular extension suspected on digital rectal exam with confirmation on MRI. Suspicion of extracapsular extension on MRI alone is not an exclusion for study enrollment.
  5. Subject is not a candidate for multiparametric MRI with contrast. Some reasons may include (but are not limited to): renal insufficiency, foreign body or pacemakers.
  6. No prior pelvic radiotherapy.
  7. No prior surgery to the prostate, other than transurethral procedures for benign prostatic hyperplasia (e.g., transurethral resection, green light laser treatment).
  8. No concurrent, active malignancy, other than non-metastatic skin cancer of any type, superficial bladder cancer, or early stage chronic lymphocytic leukemia (well-differentiated small cell lymphocytic lymphoma) or <stage IV follicular lymphoma. If a prior malignancy is in remission for ≥ 3 years then the patient is eligible.
  9. Bilateral hip replacement.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02242773

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United States, Florida
University of Miami
Miami, Florida, United States, 33136
Sponsors and Collaborators
University of Miami
National Institutes of Health (NIH)
National Cancer Institute (NCI)
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Principal Investigator: Sanoj Punnen, MD, MAS University of Miami
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Responsible Party: Sanoj Punnen, MD, MAS, Associate Professor, University of Miami
ClinicalTrials.gov Identifier: NCT02242773    
Other Study ID Numbers: 20140372
1R01CA189295-01 ( U.S. NIH Grant/Contract )
First Posted: September 17, 2014    Key Record Dates
Last Update Posted: September 16, 2022
Last Verified: September 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Product Manufactured in and Exported from the U.S.: No
Keywords provided by Sanoj Punnen, MD, MAS, University of Miami:
Active Surveillance
MRI-Guided Biopsy
Multi-parametric MRI
Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Genital Diseases, Male
Genital Diseases
Urogenital Diseases
Prostatic Diseases
Male Urogenital Diseases