Evaluation of Perilesional Biopsy in Diagnosis of Prostate Cancer

Trial Title: Evaluation of Perilesional Biopsy in Diagnosis of Prostate Cancer

NCT ID: NCT06482645

Condition: Prostate Cancer

Conditions: Official terms:
Prostatic Neoplasms

Conditions: Keywords:
Prostate cancer
Multicenter randomized controlled trial
Perilesional biopsy
Regional systematic biopsy

Study type: Interventional

Study phase: N/A

Overall status: Recruiting

Study design:

Allocation: Randomized

Intervention model: Parallel Assignment

Primary purpose: Diagnostic

Masking: Single (Outcomes Assessor)

Intervention:

Intervention type: Procedure
Intervention name: Perilesional/regional systematic biopsy
Description: The biopsy procedure was conducted by a highly skilled and experienced urologist who specializes in performing prostate biopsies. Prophylactic antibiotics were routinely used both before and one day prior to scheduled surgery. Each patient was placed in the left lateral position or lithotomy position. For each predefined mpMRI suspicious lesion, urologists obtained nine cores at 5-mm intervals within and around the region of interest (penumbra). The location of these nine cores depended on the shape and location of the suspicious lesion.
Arm group label: Perilesional/regional systematic biopsy (PB/RSB) group

Intervention type: Procedure
Intervention name: Combination of systematic biopsy and targeted biopsy
Description: The biopsy procedure was conducted by a highly skilled and experienced urologist who specializes in performing prostate biopsies. Prophylactic antibiotics were routinely used both before and one day prior to scheduled surgery. Each patient was placed in the left lateral position or lithotomy position. The ultrasound equipment used included a color Doppler ultrasound diagnostic instrument (Hitachi HiVision, Philips Epiq 7), transrectal probes, and corresponding puncture needle guns. Color Doppler examination was performed from the base to the apex. Three to five targeted biopsies from the lesion were performed within and around the predefined mpMRI suspicious lesion, followed by fore-zone 12-core biopsy.
Arm group label: Combination of systematic biopsy and targeted biopsy (TB+SB) group

Summary: The goal of this multicenter randomized controlled trial (RCT) is to evaluate the efficacy and safety of different prostate biopsy schemes, including perilesional/regional systematic biopsy (PB/RSB) and combination of systematic biopsy and targeted biopsy (TB+SB). The main questions it aims to answer are: Does PB/RSB promote the accurate diagnosis of clinically significant prostate cancer? What's the value of PB/RSB in improving the safety of prostate biopsy? Researchers will compare the cancer detection rates of PB/RSB and combination of TB+SB to explore the efficacy of different prostate biopsy schemes. They will evaluate the safety profile of different prostate biopsy schemes through the complication rates and postoperative quality of life. Participants will: Receive PB/RSB or TB+SB.

Detailed description: Currently, combination of systematic biopsy and targeted biopsy (TB+SB) has been recommended for the diagnosis of patients with suspicious lesion found on multiparametric magnetic resonance imaging (mpMRI). Although the combined biopsy approach could effectively detect clinically significant prostate cancer (csPCa), the increased number of biopsy cores would increase the risk of complications and decrease the postoperative quality of life. In recent years, urological and radiologic thinking has changed after realizing that systemic biopsies may be omitted when the chance of missing a clinically significant lesion is low, or when a systemic biopsy has already been done beforehand. More and more radiologists and urologists focused on the issue of optimization of prostate biopsy schemes. Previous studies found that the majority of csPCa were found within a band of 10-mm radius outside MRI lesions (the penumbra). Based on the penumbra theory, the perilesional/regional systematic biopsy (PB/RSB) has gradually received urologists' attention. Some studies demonstrated that the prostate cancer (PCa) detection rate was not inferior to the combined biopsy with the benefits of using fewer biopsy cores. However, the safety profile warrants further evaluation, and there is still a lack of high-quality, prospective evidence for the PB/RSB schemes. Thus, this multicenter randomized controlled trial (RCT) aims to evaluate the efficacy and safety of PB/RSB schemes and the routine TB+SB schemes, provide high-quality evidence for the optimization of prostate biopsy schemes. The main questions it aims to answer are: Does PB/RSB promote the accurate diagnosis of clinically significant prostate cancer? What is the value of PB/RSB in improving the safety of prostate biopsy? This prospective, multi-institution RCT compared the csPCa detection rates of PB/RSB and combination of TB+SB. Participants were prospectively enrolled at Peking University First Hospital (Beijing, China), Beijing Hospital (Beijing, China), and Shanghai East Hospital (Shanghai, China) from July 2024 to June 2025. Participants were randomly allocated to PB/RSB group and TB+SB group. Researchers will compare the cancer detection rates of PB/RSB and combination of TB+SB to explore the efficacy of different prostate biopsy schemes. They will evaluate the safety profile of different prostate biopsy schemes through the complication rates and postoperative quality of life. Participants will: Receive PB/RSB or TB+SB.

Criteria for eligibility:
Criteria:
Inclusion Criteria: - The age of the patient is between 45 and 85. - No previous biopsy. - Patients with single suspicious lesion, complete multiparametric magnetic resonance imaging (mpMRI) data, qualified image quality control, suspicious lesions, and Prostate Imaging Reporting and Data System version 2.1 (PI-RADS V2.1) of > 3. - Patients were in accordance with the indication of prostate biopsy, including patients with suspicious prostate nodes found by digital rectal examination (DRE), the suspicious lesions found by transrectal ultrasound (TRUS) or MRI, total prostate-specific antigen (tPSA) >10ng/mL, tPSA 4-10ng/mL with free-to-total PSA ratio (f/tPSA) <0.16 or PSA density (PSAD) >0.15. - The prostate biopsy pathological results were complete. The time interval between prostate biopsy and prostate mpMRI examination should not exceed one month. - Patients with complete clinical information. Exclusion Criteria: - The mpMRI data was unqualified or incomplete. - Patients had received radiotherapy, chemotherapy, androgen deprivation therapy, or surgery treatment before prostate mpMRI examination or prostate biopsy. - Patients with previous biopsy. - Patients with PI-RADS V2.1 of < 4. - Patients were not in accordance with the indication of prostate biopsy. - The patient could not cooperate to complete the prostate biopsy. - The patients or their family members refused to participate in this study. - Patients with incomplete clinical information.

Gender: Male

Minimum age: 45 Years

Maximum age: 85 Years

Healthy volunteers: No

Locations:

Facility:
Name: Peking University First Hospital

Address:
City: Beijing
Zip: 100034
Country: China

Status: Recruiting

Contact:
Last name: Baowei Zhang

Phone: +86 83572466
Email: bdyyll@126.com

Start date: July 1, 2024

Completion date: June 30, 2026

Lead sponsor:
Agency: Peking University First Hospital
Agency class: Other

Collaborator:
Agency: Beijing Hospital
Agency class: Other

Collaborator:
Agency: Shanghai East Hospital
Agency class: Other

Source: Peking University First Hospital

Record processing date: ClinicalTrials.gov processed this data on November 12, 2024

Source: ClinicalTrials.gov page: https://clinicaltrials.gov/ct2/show/NCT06482645