SmartTarget: BIOPSY

University College, London134 enrolled

Overview

The purpose of this study is to determine how well SmartTarget guided prostate biopsies perform, compared with our current standard of "visually directed biopsies" in the detection of prostate cancer. The diagnosis of prostate cancer is dependent upon sampling the prostate to confirm disease. Standard trans-rectal biopsies are taken in a random fashion, without prior knowledge of the disease location. Transperineal mapping biopsies overcome this by systematically samples the entire gland but are very intensive and time consuming to perform. An alternative method is to perform targeted prostate biopsies where an MRI prior to biopsy can be used to inform doctors about the location of the disease. This is a difficult procedure to perform as it requires the surgeon to mentally translate the location of disease on MRI image to the live ultrasound seen in theatre. SmartTarget may help this procedure by providing guidance to the location of the disease by fusing the MRI image onto the live ultrasound, thereby providing the clinician a target to biopsy. This trial will compare the outcomes of "visually directed biopsies" with those directed by SmartTarget

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

134

Conditions

Prostatic Neoplasms Diagnostic Techniques and Procedures

Eligibility

Sex: MALE

Medical Language ↔ Plain English

Inclusion Criteria: * Previous TRUS biopsy with clinical indication for repeat biopsy * Discrete lesion on mpMRI scoring 3, 4 or 5 on PI-RADs scale * An understanding of the English language sufficient to understand written and verbal information about the trial and consent process * Signed informed consent Exclusion Criteria: * Men who have taken any form of hormones (except 5-alpha reductase inhibitors) within the last 6 months * Men with an irreversible coagulopathy predisposing to bleeding * Men who are unability to undergo transrectal ultrasonography * Men who have had previous radiation therapy to the pelvis * Men who have had HIFU, cryosurgery, thermal, irreversible electroporation, photodynamic, photothermal therapy, or microwave therapy to the prostate. Transurethral resection or vaporization of the prostate for benign prostatic hyperplasia using any energy modality is permitted * Men with evidence of metastatic disease or nodal disease outside the prostate on bone scan or cross-sectional imaging * Men who are unable to give informed consent

Outcomes

Primary Outcomes

Cancer Detection

The proportion of men with clinically significant disease based on SmartTarget guided biopsy compared to the proportion of men with clinically significant disease based on visually-directed biopsy.

Time frame: Within 3 weeks of biopsy

Secondary Outcomes

Targeting Efficiency (core length, grade)

The targeting efficiency of the SmartTarget guided biopsies versus visually-directed biopsies measured by: Number of cores required to obtain the highest cancer risk category Number of cores with cancer Maximum Cancer Core Length and Total Cancer Core Length Highest Grade Cancer

Time frame: Within 3 weeks of Biopsy

Clinical Usability (length of procedure, generation time, re-registration rate, failure rate)

To evaluate the clinical usability of SmartTarget guided biopsy as measured by: Length of Procedure SmartTarget model generation time SmartTarget re-registration rate SmartTarget failure rate

Time frame: During Procedure

Quality of Life

To assess how this biopsy strategy impacts on quality of life as measured using validated questionnaires: IPSS IIEF EQ5D - 5L

Time frame: 6 Weeks post biopsy