PSMA-PET + MRI for Prostate Cancer

Recruiting in Palo Alto (17 mi)

Overseen by Clinton Bahler, MD

Age: 18+

Sex: Male

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2 & 3

Recruiting

Sponsor: Five Eleven Pharma, Inc.

Disqualifiers: Other trials, MRI safety, significant illness

No Placebo Group

Prior Safety Data

Trial Summary

What is the purpose of this trial?

This trial is comparing two groups of patients undergoing surgery. One group will receive the usual imaging scan, while the other group will get an additional special scan that uses a dye to make cancer cells more visible. This new imaging method may help doctors plan surgeries better and improve patient outcomes.

Do I need to stop my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment PSMA-PET + MRI for prostate cancer?

Research shows that combining PSMA-PET with MRI improves the detection of significant prostate cancer compared to using MRI alone. This combination has high sensitivity, meaning it is very good at correctly identifying patients with prostate cancer, especially for certain types of lesions. ^{1 2 3 4 5}

Is PSMA-PET + MRI safe for use in humans?

Research shows that 68Ga-THP PSMA PET/CT, a similar imaging method, is generally safe in humans, with no serious adverse events reported. Some minor side effects like itching and rash at the injection site were noted, but no participants had to leave the study because of these effects. ^{6 7 8 9 10}

How is the PSMA-PET + MRI treatment different from other prostate cancer treatments?

The PSMA-PET + MRI treatment is unique because it combines advanced imaging techniques to better detect and stage prostate cancer. This approach uses a special imaging agent, 68Ga-PSMA-11, which targets prostate-specific membrane antigen (PSMA) to provide more accurate and detailed images than traditional methods, helping to identify cancer spread more effectively. ^{2 3 11 12 13}

Research Team

Clinton Bahler, MD

Principal Investigator

Indiana University School of Medicine

Eligibility Criteria

Men with significant prostate cancer planning to undergo surgery can join. They should have a certain level of prostate cancer severity, based on Gleason scores, and wish to maintain erections post-treatment. Men with any serious health issues, participating in other radiation trials recently, or unable to stay still for imaging due to physical limits or claustrophobia cannot participate.

Inclusion Criteria

I want to keep my ability to have erections after treatment.

My prostate cancer is aggressive based on my biopsy results.

I am a man with prostate cancer opting for surgery to remove my prostate.

Exclusion Criteria

I cannot stay still on a PET or MRI machine due to physical issues or claustrophobia.

I do not have any major health issues that could interfere with the study.

Participation in another investigational trial involving research exposure to ionizing radiation concurrently or within 30 days

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-surgical Imaging

Participants undergo standard of care MRI and possibly PSMA PET scan prior to surgery

1 month

Surgery

Participants undergo prostatectomy surgery with surgical plans potentially influenced by imaging findings

Follow-up

Participants are monitored for safety and effectiveness after surgery, including assessments of incontinence, erectile function, and overall health

18 months

Treatment Details

Interventions

• PSMA-PET and SOC MRI (Diagnostic Test)
• SOC MRI (Diagnostic Test)

Trial Overview The trial is testing if adding a PSMA-PET scan alongside the standard MRI before surgery provides better information than just the MRI alone. The study will see if this extra scan changes surgical plans and improves outcomes by comparing two groups: one gets only an MRI and the other gets both an MRI and PSMA-PET.

Participant Groups

Group I: PSMA-PET and SOC MRI prior to surgery Experimental Treatment 1 Intervention

Group II: SOC MRI prior to surgery Active Control 1 Intervention

Who Is Running the Clinical Trial?

Five Eleven Pharma, Inc.

Lead Sponsor

Trials

6

Recruited

410+

Indiana University

Collaborator

Trials

1,063

Recruited

1,182,000+

Alan Palkowitz

Indiana University

Chief Executive Officer since 2020

PhD in Chemistry from Indiana University

David Ingram

Indiana University

Chief Medical Officer since 2020

MD from Indiana University School of Medicine

Findings from Research

In a study of 79 men with newly diagnosed prostate cancer, 18F-PSMA-1007 PET/CT demonstrated a significantly higher sensitivity (87%) for detecting pelvic lymph node metastases compared to whole-body MRI with diffusion-weighted imaging (45%) and standard CT (26%).

The 18F-PSMA-1007 PET/CT maintained high specificity (98%), indicating it is a more effective imaging modality for primary nodal staging in prostate cancer while accurately identifying malignant lymph nodes that other methods missed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prospective comparison of 18F-PSMA-1007 PET/CT, whole-body MRI and CT in primary nodal staging of unfavourable intermediate- and high-risk prostate cancer. Malaspina, S., Anttinen, M., Taimen, P., et al.[2023]

PSMA PET/MRI is more accurate than traditional methods like multiparametric MRI and PET alone for diagnosing primary prostate cancer, based on a systematic review of 10 studies.

The pooled sensitivity of PSMA PET/MRI in detecting primary prostate cancer is very high at 97.6%, indicating it is particularly effective, especially for patients with PIRADS 3 lesions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Systematic Review and Metanalysis on the Role of Prostate-Specific Membrane Antigen Positron Emission Tomography/Magnetic Resonance Imaging for Intraprostatic Tumour Assessment. Mapelli, P., Ghezzo, S., Spataro, A., et al.[2023]

68Ga-PSMA PET/MRI has demonstrated high diagnostic accuracy for staging primary prostate cancer, showing equivalent effectiveness to 68Ga-PSMA PET/CT in detecting critical features like extracapsular extension, seminal vesicle invasion, and lymph node metastasis.

The analysis included 27 studies, indicating that while both imaging modalities are effective, further direct comparisons are necessary to fully establish the advantages of 68Ga-PSMA PET/MRI over PET/CT in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of 68Ga-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography/Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography for Primary Staging of Prostate Cancer: A Systematic Review and Meta-analysis. Ling, SW., de Jong, AC., Schoots, IG., et al.[2022]

In a study of 54 patients, combining 68Ga-PSMA PET/CT with multiparametric MRI (PET/MRI) significantly improved the detection of clinically significant prostate cancer compared to MRI alone, with a sensitivity increase from 76% to 89%.

PET/MRI showed better diagnostic performance for lesions classified as PI-RADS 3, indicating that this combination imaging technique can enhance the identification of potentially serious prostate cancer without compromising specificity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Combination of 68Ga-PSMA PET/CT and Multiparametric MRI Improves the Detection of Clinically Significant Prostate Cancer: A Lesion-by-Lesion Analysis. Chen, M., Zhang, Q., Zhang, C., et al.[2021]

In a pilot study of 62 patients with suspected or defined prostate cancer, PSMA-PET/MRI imaging led to a change in management strategies for 41.9% of patients, indicating its potential clinical utility in guiding treatment decisions.

The most significant impact of PSMA-PET/MRI was observed in patients with biochemical recurrent prostate cancer, particularly those with PSA levels between 0.5 and 1 ng/ml, suggesting that this imaging technique can help refine treatment approaches in this group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Utility of 18F-PSMA-1007 Positron Emission Tomography/Magnetic Resonance Imaging in Prostate Cancer: A Single-Center Experience. Liu, A., Zhang, M., Huang, H., et al.[2022]

The study demonstrated that a comprehensive whole-body 18F-PSMA-1007-PET/MRI protocol is feasible and reproducible for imaging prostate cancer in eight high-risk patients, effectively detecting dominant lesions and providing complementary staging information.

The results showed strong correlation between SUVmean values from PET/CT and PET/MRI, indicating that this combined imaging approach can enhance the accuracy of prostate cancer assessment while minimizing artifacts, thus improving patient management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Simultaneous whole-body 18F-PSMA-1007-PET/MRI with integrated high-resolution multiparametric imaging of the prostatic fossa for comprehensive oncological staging of patients with prostate cancer: a pilot study. Freitag, MT., Kesch, C., Cardinale, J., et al.[2019]

68Ga-PSMA-11, developed by UCLA and UCSF, received FDA approval on December 1, 2020, as the first drug specifically for PET imaging of prostate cancer lesions, marking a significant advancement in prostate cancer diagnostics.

The approval followed a pivotal phase 3 clinical trial, highlighting the drug's efficacy in identifying PSMA-positive lesions, which is crucial for improving treatment planning in men with prostate cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

68Ga-PSMA-11 NDA Approval: A Novel and Successful Academic Partnership. Carlucci, G., Ippisch, R., Slavik, R., et al.[2022]

The guideline aims to standardize the use of 68Ga-PSMA PET/CT imaging for prostate cancer, enhancing its accuracy and reliability in both research and clinical settings.

By establishing clear recommendations for the performance and reporting of this imaging technique, the guideline seeks to improve the overall effectiveness of prostate cancer diagnosis and treatment monitoring.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

68Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. Fendler, WP., Eiber, M., Beheshti, M., et al.[2022]

Targeted iron oxide nanoparticles (TBNPs and TDNPs) using PSMA-11 peptides showed significantly enhanced MRI contrast for detecting prostate cancer tumors in a mouse model, achieving up to 88.6% relative signal enhancement compared to muscle tissue.

The study suggests that using targeted nanoparticles allows for a reduction in the required dose of non-targeted iron oxide nanoparticles, making the detection process more efficient and potentially safer for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Molecular MR Imaging of Prostate Cancer by Specified Iron Oxide Nanoparticles With PSMA-11 Peptides: A Preclinical Study. Ghorbani, F., Aminzadeh, B., Borji, N., et al.[2023]

In a study of ten patients with primary prostate cancer, both multi-parametric MRI (MP-MRI) and PSMA-PET/CT effectively identified tumor locations, showing high agreement in tumor staging based on biopsy results.

PSMA-PET/CT demonstrated a strong correlation with MP-MRI, identifying tumors in 89.4% of sections marked by MP-MRI and 96.8% of sections marked by PSMA-PET, suggesting that PSMA-PET/CT could be a reliable alternative for staging prostate cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intra-individual comparison of (68)Ga-PSMA-11-PET/CT and multi-parametric MR for imaging of primary prostate cancer. Giesel, FL., Sterzing, F., Schlemmer, HP., et al.[2022]

PSMA PET/MRI is a promising imaging technique for detecting primary prostate cancer, showing higher accuracy compared to traditional multiparametric MRI.

This imaging modality is also effective for restaging and detecting tumor recurrence in prostate cancer patients, even when prostate-specific antigen levels are low, although more research is needed to establish definitive recommendations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Role of Prostate-specific Membrane Antigen Positron Emission Tomography/Magnetic Resonance Imaging in Primary and Recurrent Prostate Cancer: A Systematic Review of the Literature. Manfredi, C., Fernández-Pascual, E., Arcaniolo, D., et al.[2022]

In a study of 144 patients, 68Ga-PSMA PET/CT showed a slightly lower sensitivity (83.1%) compared to mpMRI (90.1%) for detecting prostate cancer lesions, but it was more effective at identifying larger lesions that mpMRI missed.

68Ga-PSMA PET/CT provided additional detection of prostate cancer lesions, identifying 13.5% more index lesions and 18.2% more total lesions compared to mpMRI, suggesting it offers incremental value in the diagnostic process for prostate cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

68Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is 68Ga-PSMA PET/CT guided biopsy the future? Donato, P., Morton, A., Yaxley, J., et al.[2021]

References

1. Germany pubmed.ncbi.nlm.nih.gov

Prospective comparison of 18F-PSMA-1007 PET/CT, whole-body MRI and CT in primary nodal staging of unfavourable intermediate- and high-risk prostate cancer. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Systematic Review and Metanalysis on the Role of Prostate-Specific Membrane Antigen Positron Emission Tomography/Magnetic Resonance Imaging for Intraprostatic Tumour Assessment. [2023]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Comparison of 68Ga-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography/Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography for Primary Staging of Prostate Cancer: A Systematic Review and Meta-analysis. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Combination of 68Ga-PSMA PET/CT and Multiparametric MRI Improves the Detection of Clinically Significant Prostate Cancer: A Lesion-by-Lesion Analysis. [2021]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Clinical Utility of 18F-PSMA-1007 Positron Emission Tomography/Magnetic Resonance Imaging in Prostate Cancer: A Single-Center Experience. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

A Phase II, Open-label study to assess safety and management change using 68Ga-THP PSMA PET/CT in patients with high risk primary prostate cancer or biochemical recurrence after radical treatment: The PRONOUNCED study. [2022]

7. Germany pubmed.ncbi.nlm.nih.gov

Simultaneous whole-body 18F-PSMA-1007-PET/MRI with integrated high-resolution multiparametric imaging of the prostatic fossa for comprehensive oncological staging of patients with prostate cancer: a pilot study. [2019]

8. United States pubmed.ncbi.nlm.nih.gov

68Ga-PSMA-11 NDA Approval: A Novel and Successful Academic Partnership. [2022]

9. Germany pubmed.ncbi.nlm.nih.gov

68Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Molecular MR Imaging of Prostate Cancer by Specified Iron Oxide Nanoparticles With PSMA-11 Peptides: A Preclinical Study. [2023]

11. Germany pubmed.ncbi.nlm.nih.gov

Intra-individual comparison of (68)Ga-PSMA-11-PET/CT and multi-parametric MR for imaging of primary prostate cancer. [2022]

12. Netherlands pubmed.ncbi.nlm.nih.gov

The Role of Prostate-specific Membrane Antigen Positron Emission Tomography/Magnetic Resonance Imaging in Primary and Recurrent Prostate Cancer: A Systematic Review of the Literature. [2022]

13. Germany pubmed.ncbi.nlm.nih.gov

68Ga-PSMA PET/CT better characterises localised prostate cancer after MRI and transperineal prostate biopsy: Is 68Ga-PSMA PET/CT guided biopsy the future? [2021]