Pilot Study of (MR) Imaging With Pyruvate (13C) to Detect High Grade Prostate Cancer

Early Phase 1RecruitingNCT02526368

Ivan de Kouchkovsky, MD80 enrolled

Overview

This pilot clinical trial studies how well magnetic resonance spectroscopic imaging (MRSI) with hyperpolarized carbon 13 (13C) pyruvate alone or in combination with 13C 15N2 Urea works in finding prostate cancer that exhibits poorly differentiated or undifferentiated cells (high-grade) and that is restricted to the site of origin, without evidence of spread (localized) in patients undergoing radical prostatectomy. Diagnostic procedures, such as MRSI with hyperpolarized carbon (13C) pyruvate, may aid in the diagnosis of prostate cancer and in discriminating high-grade from low-grade prostate cancer and benign adjacent prostate tissue

PRIMARY OBJECTIVES: I. To investigate the association between hyperpolarized (HP) pyruvate-to-lactate conversion (kPL) and HP urea perfusion with histologic grade of prostate cancer, including benign prostate tissue, low grade disease (primary Gleason score \< 4), and high grade (primary Gleason score \>= 4) prostate cancer (Cohort A). II. To investigate the association between HP pyruvate-to-lactate conversion (kPL) and HP urea perfusion with in-field clinically significant (Gleason score \>3+3) recurrent/residual prostate cancer following non-investigational High-Intensity Focused Ultrasound (HIFU) focal therapy (Cohort B) SECONDARY OBJECTIVES: I. Safety. II. To determine the optimal cut-off value of peak lactate to pyruvate ratio (lac/pyr), lac/pyr area under the curve (AUC), 13C pyruvate to lactate (kPL) rate, urea AUC, and urea transfer constant (ktrans) on magnetic resonance imaging (MRI) that accurately detects primary Gleason 4 component cancer (Cohort A). III. To determine the optimal cut-off value of peak lac/pyr, lac/pyr AUC, kPL Urea AUC, Urea ktrans and kPL-urea product (kUP) on MRI that accurately detects in-field clinically significant (ie. Gleason score \>3+3) recurrent/residual prostate cancer (Cohort B only). IV. To determine the reproducibility of peak lac/pyr, lac/pyr AUC and kPL, urea AUC and urea transfer constant (ktrans) with same-day repeated dose studies. with same-day repeated dose studies. V. To compare peak lac/pyr, lac/pyr AUC and kPL, urea AUC, urea transfer constant (ktrans) on MRI with Prostate Imaging-Reporting and Data System (PI-RADS) assessment of multiparametric MRI in predicting regions of cancer versus benign tissue. EXPLORATORY OBJECTIVES: I. To correlate histologic markers, including lactate dehydrogenase A (LDHA) expression and activity level, along with Ki-67, MYC, and MCT 1 and 4 expression, with peak intra-tumoral lac/pyr ratio, lactate AUC, and kPL detected using anatomically aligned magnetic resonance (MR) cross-sectional images of the prostate gland. II. To test for an association between mean intra-tumoral lac/pyr signal and lactate AUC, kPL, urea AUC, and urea transfer constant (ktrans) with adverse clinical and pathologic characteristics including extracapsular extension, positive nodal involvement, and failure to achieve undetectable prostate specific antigen (PSA) nadir following prostatectomy. OUTLINE: Participants receive either hyperpolarized carbon pyruvate (13C) or co-polarized 13C pyruvate and 13C, 15N2urea intravenously (IV) and undergo MRSI within 12 weeks of undergoing non-investigational radical prostatectomy (cohort A) or non-investigational systematic and MR-targeted biopsies (cohort B). Participants may receive optional second hyperpolarized 13C injection and dynamic 13C MRI scan performed within 15 to 60 minutes following completion of first scan. After completion of study, participants are followed up at 24 hours.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Interventions

Hyperpolarized 13C-PyruvateDRUG

Given IV

Hyperpolarized 13C,15N2-ureaDRUG

Given IV

Magnetic Resonance Spectroscopic ImagingPROCEDURE

Undergo MRSI

Eligibility

Sex: MALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Biopsy-proven adenocarcinoma of the prostate. Biopsy may be performed outside of University of California, San Francisco (UCSF), if detailed results of sextant biopsy are available. For Cohort A only, a minimum of 20 participants out of a planned enrollment of 50 patients must have high-risk disease as defined by primary Gleason score of 4 or 5 on prior prostate biopsy. * Cohort A only: Planned radical prostatectomy at UCSF within 12 weeks following protocol MRI/MRSI. * Cohort B only: HIFU focal therapy completed within 18 months of protocol MRI/MRSI, and planned systematic and MR-guided biopsy at UCSF within 12 weeks following protocol MRI/MRSI. * The participant is able and willing to comply with study procedures and provide signed and dated informed consent * Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 Exclusion Criteria: * Participants who because of age less than 18 years old, general medical or psychiatric condition, or physiologic status cannot give valid informed consent. * Participants unwilling or unable to undergo MR imaging, including patients with contraindications to MRI, such as cardiac pacemakers or non-compatible intracranial vascular clips. * Participants who cannot tolerate or have contra-indications to endorectal coil insertion; for example, participants with a prior abdominoperineal resection of the rectum or latex allergy. Note: The use of an endorectal coil may be waived at the discretion of the Principal Investigator upon review of available imaging with radiology, in which case this exclusion criterion will not apply. * Patients with contra-indications to injection of gadolinium contrast; for example patients with prior documented allergy or those with inadequate renal function. * Metallic hip implant or any other metallic implant or device that distorts local magnetic field and compromises the quality of MR imaging. * Cryosurgery, surgery for prostate cancer, prostatic or pelvic radiotherapy prior to study enrollment. For Cohort B, HIFU focal therapy is allowed. No limit on number of prior prostate biopsies; prior transurethral prostatic resection (TURP) is not allowed. * Current or prior androgen deprivation therapy. For Cohort A, a history of use of a 5-alpha reductase inhibitor is allowed, provided it was discontinued at least one month prior to study entry. For cohort B, a history of use of 5-α reductase inhibitor is allowed, provided it is discontinued at least 14 days to protocol MRI/MRSI. * Poorly controlled hypertension, with blood pressure at study entry \> 160/100; the addition of anti-hypertensives to control blood pressure is allowed for eligibility determination. * Congestive heart failure or New York Heart Association (NYHA) status \>= 2. * A history of clinically significant electrocardiography (EKG) abnormalities, including QT prolongation, a family history of prolonged QT interval syndrome, or myocardial infarction (MI) within 6 months of study entry; patients with rate-controlled atrial fibrillation/flutter will be allowed on study.

Locations (1)

University of California, San Francisco

San Francisco, California, United States

RECRUITING

Outcomes

Primary Outcomes

Mean peak intra-tumoral lactate/pyruvate (lac/pyr) ratio by pathological grade (Cohort A)

Means and standard deviations for lactate area under curve will be calculated by pathologic grade (benign, low grade (primary Gleason score \<4) and high grade (primary Gleason score \>4)).

Time frame: Baseline, 1 day

Mean peak intra-tumoral lactate/pyruvate (lac/pyr) ratio (Cohort B)

Means and standard deviations for lactate area under curve will be calculated for those with in-field recurrent/residual clinically significant prostate cancer.

Time frame: Baseline, 1 day

Mean lactate area under curve (AUC) by pathological grade (Cohort A)

Means and standard deviations for lactate area under curve will be calculated by pathologic grade (benign, low grade (primary Gleason score \<4) and high grade (primary Gleason score \>4)). A One-way ANOVA model will be used to compare lactate area under curve by pathologic grade (benign, low grade (primary Gleason score \<4) and high grade (primary Gleason score \>4)).

Time frame: Baseline, 1 day

Mean lactate area under curve (AUC) (Cohort B)

Means and standard deviations for lactate area under curve will be calculated for those with in-field recurrent/residual clinically significant prostate cancer.

Time frame: Baseline, 1 day

Mean peak conversion of HP 13C pyruvate to lactate (kPL) by pathological grade (Cohort A)

Means and standard deviations for kPL will be calculated by pathologic grade (benign, low grade (primary Gleason score \<4) and high grade (primary Gleason score \>4)).

Time frame: Baseline, 1 day

Mean peak conversion of HP 13C pyruvate to lactate (kPL) (Cohort B)

Means and standard deviations for kPL will be calculated for those with in-field recurrent/residual clinically significant prostate cancer.

Time frame: Baseline, 1 day

Mean Urea AUC by pathological grade (Cohort A)

Means and standard deviations for Urea AUC will be calculated by pathologic grade (benign, low grade (primary Gleason score \<4) and high grade (primary Gleason score \>4)).

Time frame: Baseline, 1 day

Mean Urea AUC (Cohort B)

Means and standard deviations for Urea AUC will be calculated for those with in-field recurrent/residual clinically significant prostate cancer.

Time frame: Baseline, 1 day

Mean urea transfer constant (Ktrans) by pathological grade (Cohort A)

Means and standard deviations for Ktrans will be calculated by pathologic grade (benign, low grade (primary Gleason score \<4) and high grade (primary Gleason score \>4)).

Time frame: Baseline, 1 day

Mean urea transfer constant (Ktrans) (Cohort B)

Means and standard deviations for Ktrans will be calculated for those with in-field recurrent/residual clinically significant prostate cancer.

Time frame: Baseline, 1 day

Secondary Outcomes

Optimal cut-off value of peak lactate to pyruvate ratio (lac/pyr) (Cohort A)

Receiver-operative-curve analyses will be performed to determine the optimal cut-point of peak lac/pyr AUC on MRI that accurately detect primary Gleason 4 prostate cancer.

Time frame: Baseline, 1 day

Optimal cut-off value of peak lactate to pyruvate ratio (lac/pyr) (Cohort B)

Receiver-operative-curve analyses will be performed to determine the optimal cut-point of peak lac/pyr AUC on MRI that accurately detects in-field clinically significant (i.e. Gleason score \>3+3) recurrent/residual prostate cancer.

Time frame: Baseline, 1 day

Optimal cut-off value of lac/pyr area under the curve (AUC) (Cohort A)

Receiver-operative-curve analyses will be performed to determine the optimal cut-point of peak lac/pyr AUC values on MRI that accurately detect primary Gleason 4 prostate cancer

Time frame: Baseline, 1 day

Optimal cut-off value of lac/pyr area under the curve (AUC) (Cohort B)

Receiver-operative-curve analyses will be performed to determine the optimal cut-point of peak lac/pyr AUC values on MRI that accurately detects in-field clinically significant (ie. Gleason score \>3+3) recurrent/residual prostate cancer

Time frame: Baseline, 1 day

Optimal cut-off value of 13C pyruvate to lactate (kPL) rate (Cohort A)

Receiver-operative-curve analyses will be performed to determine the optimal cut-point of kPL on MRI that accurately detect primary Gleason 4 prostate cancer.

Time frame: Baseline, 1 day

Optimal cut-off value of 13C pyruvate to lactate (kPL) rate (Cohort B)

Receiver-operative-curve analyses will be performed to determine the optimal cut-point of kPL on MRI that accurately detects in-field clinically significant (ie. Gleason score \>3+3) recurrent/residual prostate cancer

Time frame: Baseline, 1 day

Central Contacts

Louise Magat

CONTACT

(415) 502-1822 Louise.Magat@ucsf.edu

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.

Optimal cut-off value of urea AUC (Cohort A)

Receiver-operative-curve analyses will be performed to determine the optimal cut-point of urea AUC on MRI that accurately detect primary Gleason 4 prostate cancer.

Time frame: Baseline, 1 day

Optimal cut-off value of urea AUC (Cohort B)

Receiver-operative-curve analyses will be performed to determine the optimal cut-point of urea AUC on MRI that accurately detects in-field clinically significant (ie. Gleason score \>3+3) recurrent/residual prostate cancer

Time frame: Baseline, 1 day

Optimal cut-off value of urea transfer constant (ktrans) (Cohort A)

Receiver-operative-curve analyses will be performed to determine the optimal cut-point of urea ktrans on MRI that accurately detect primary Gleason 4 prostate cancer.

Time frame: Baseline, 1 day

Optimal cut-off value of urea transfer constant (ktrans) (Cohort B)

Receiver-operative-curve analyses will be performed to determine the optimal cut-point of urea ktrans on MRI that accurately detects in-field clinically significant (ie. Gleason score \>3+3) recurrent/residual prostate cancer

Time frame: Baseline, 1 day

Proportion of participants with Treatment-Related Adverse Events

Assessment of the occurrence of clinically significant changes in safety variables from baseline. Safety endpoints include monitoring for the occurrence of treatment-emergent AEs. Toxicities will be graded using the National Cancer Institute (NCI) Common Terminology (Toxicity) Criteria for Adverse Events (CTCAE) version 4.0.

Time frame: Baseline, 1 day

Compare lactate/pyruvate area under curve (AUC) with Prostate Imaging Reporting and Data System (PI-RADS)

To compare lactate/pyruvate AUC on MRI with PI-RADS assessment of multiparametric MRI in predicting regions of cancer versus benign tissue. Radiologists use the PI-RADS to report how likely it is that a suspicious area is a clinically significant cancer. PI-RADS scores range from 1 (most likely not cancer) to 5 (very suspicious).

Time frame: Baseline, 1 day

Compare peak lactate/pyruvate with PI-RADS

To compare peak lactate/pyruvate on MRI with PI-RADS assessment of multiparametric MRI in predicting regions of cancer versus benign tissue. Radiologists use the PI-RADS to report how likely it is that a suspicious area is a clinically significant cancer. PI-RADS scores range from 1 (most likely not cancer) to 5 (very suspicious).

Time frame: Baseline, 1 day

Compare pyruvate to lactate (kPL) with PI-RADS

To compare peak pyruvate to lactate (kPL) on MRI with PI-RADS assessment of multiparametric MRI in predicting regions of cancer versus benign tissue. Radiologists use the PI-RADS to report how likely it is that a suspicious area is a clinically significant cancer. PI-RADS scores range from 1 (most likely not cancer) to 5 (very suspicious).

Time frame: Baseline, 1 day

Compare urea AUC with PI-RADS

To compare urea AUC on MRI with PI-RADS assessment of multiparametric MRI in predicting regions of cancer versus benign tissue. Radiologists use the PI-RADS to report how likely it is that a suspicious area is a clinically significant cancer. PI-RADS scores range from 1 (most likely not cancer) to 5 (very suspicious).

Time frame: Baseline, 1 day

Compare urea transfer constant (Ktrans) with PI-RADS

To compare urea ktrans on MRI with PI-RADS assessment of multiparametric MRI in predicting regions of cancer versus benign tissue. Radiologists use the PI-RADS to report how likely it is that a suspicious area is a clinically significant cancer. PI-RADS scores range from 1 (most likely not cancer) to 5 (very suspicious).

Time frame: Baseline, 1 day

Mean difference in Intra-patient peak lac/pyr

Intra-patient reproducibility of peak lac/pyr for patients who undergo repeated dose imaging studies, as descriptively reported using summary statistics.

Time frame: Baseline, 1 day

Mean difference in Intra-patient lac/pyr AUC

Intra-patient reproducibility of lac/pyr AUC for patients who undergo repeated dose imaging studies, as descriptively reported using summary statistics.

Time frame: Baseline, 1 day

Mean difference in Intra-patient kPL

Intra-patient reproducibility of kPL for patients who undergo repeated dose imaging studies, as descriptively reported using summary statistics.

Time frame: Baseline, 1 day

Mean difference in Intra-patient Urea AUC

Intra-patient reproducibility of Urea AUC for patients who undergo repeated dose imaging studies, as descriptively reported using summary statistics.

Time frame: Baseline, 1 day

Mean difference in Intra-patient Urea ktrans

Intra-patient reproducibility of Urea ktrans for patients who undergo repeated dose imaging studies, as descriptively reported using summary statistics

Time frame: Baseline, 1 day

Pilot Study of (MR) Imaging With Pyruvate (13C) to Detect High Grade Prostate Cancer

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts