Diagnosing Clinically Significant Prostate Cancer In African American and White Men With Elevated PSA
Diagnosing Clinically Significant Prostate Cancer In African American and White Men With Elevated PSA
This randomized phase II trial studies how well systematic random biopsy or magnetic
 resonance imaging (MRI)-ultrasound image (US) fusion biopsy work in diagnosing prostate
 cancer in patients with elevated prostate specific antigen. Systematic random biopsy and
 MRI-US fusion biopsy may work better in improving the accuracy of prostate cancer detection.
PRIMARY OBJECTIVES:

 I. To compare the detection of clinically significant prostate cancer (CSPCa) in Arm 1 versus
 Arm 2.

 II. To compare between African American (AA) and white men the probability of developing
 CSPCa within three years of initial biopsy at the start of the study.

 SECONDARY OBJECTIVES:

 I. To determine complications and patient morbidity associated with either systematic random
 prostate biopsy (SR-Bx) versus (vs) magnetic resonance imaging-ultrasound image fusion biopsy
 (MRUS-Bx) + SR-Bx.

 TERTIARY OBJECTIVES:

 I. To compare Gleason score between MRUS-Bx and radical prostatectomy (RP) specimen among men
 who elect RP (~110 in the randomized controlled trial [RCT]).

 II. To assess within Arm 1 the detection of CSPCa three months after SR-Bx among men
 initially diagnosed with clinically insignificant prostate cancer (CinsPCa) or no cancer.

 III. To identify among men invited to participate and those actually enrolled in the RCT:
 determinants of study participation.

 IV. To identify among men invited to participate and those actually enrolled in the RCT:
 determinants of treatment decision (active surveillance [AS] vs radiation vs RP) including
 the diagnostic method.

 OUTLINE: Patients are randomized into 1 of 2 arms.

 ARM I: SR-Bx group

 -  Patients undergo SR-Bx

 -  If SR-Bx doesn't reveal clinically significant cancer, then MRI in 3 months, and if
 lesion is present (PIRADS ≥ 3) schedule for MRUS-Bx.

 -  If there is no lesion, then no biopsy - schedule MRI in 12 months after the initial
 MRI.

 ARM II: MRUS-Bx group

 -  Patients undergo MRI. Must be scheduled at least 1 day before MRUS Biopsy.

 -  MRI shows no lesion present (PIRADS 1-2): no MRUS-Bx, schedule for SR-Bx only.

 -  MRI lesion present (PIRADS ≥ 3): schedule for MRUS-Bx, which will be done first and
 followed immediately after by SR-Bx.

 FOLLOW UP:

 After completion of procedure, patients are followed up at 2-4 weeks, 3, 6, 9, and 12 months,
 and then periodically for up to 5 years.
Inclusion Criteria:

 -  Written informed consent and Health Insurance Portability and Accountability Act
 (HIPAA) authorization for release of personal health information

 -  Note: HIPAA authorization may be included in the informed consent or obtained
 separately

 -  Eastern Cooperative Oncology Group (ECOG) performance status of =< 1 within 3 months
 (93 days) prior to being registered for protocol

 -  African-American or white men (Hispanic or non-Hispanic)

 -  Prostate biopsy-naive or a single negative biopsy

 -  Having elevated prostate specific antigen (PSA) (> 2.5 ng/ml) and no palpable nodule
 on digital rectal exam (DRE)

 -  Ability to understand the willingness to sign a written informed consent

 -  Patients must be willing to undergo a radiologic imaging before and after biopsy of
 the prostate

 -  Patients must be willing to undergo a biopsy of the prostate

 Exclusion Criteria:

 -  Patients who have had chemotherapy or radiotherapy within 12 months of the study for
 other diagnoses not related to prostate cancer

 -  Patients receiving any other investigational agents

 -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
 infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
 arrhythmia, or psychiatric illness/social situations that would limit compliance with
 study requirements

 -  Patients with active inflammatory bowel disease

 -  Patients who are unable to undergo MRI

 -  Patients who had any surgery of the prostate including TURP (transurethral resection
 of the prostate)

 -  Patients who had > 1 prior prostate biopsy