Study of Rates of Prostate Cancer Diagnosis in Men of African Ancestry Using MRI and MRI Guided Biopsy

Study Overview
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Brief Summary
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Background: Prostate cancer (PCa) is one of the most common cancers in American men; it is a leading cause of death. Men of African ancestry have a higher rate of prostate cancer, and a higher likelihood of death, compared to men of European ancestry. The reasons for these higher rates are not known; they may include genetic and environmental factors. Better screening methods are needed. Objective: To test an imaging technology called multiparametric magnetic resonance imaging (mpMRI) for detecting prostate cancer in men of African ancestry. Eligibility: Men of African ancestry aged 35 years or older with prostate cancer and/or a strong family history of prostate cancer. Design: Participants will be screened. They will have a physical exam with blood and urine tests. Participants will have an mpMRI. They will lie on a narrow bed that slides into a large cylinder. They will lie still for about 45 minutes. They will hear loud noises during the scan; they may wear earplugs or headphones to muffle the sound. Some participants may have a dye injected into a vein. If the scan indicates participants risk of prostate cancer is medium or high, they will have a biopsy: The area will be numbed, and samples of tissue will be removed from the prostate. The biopsy will be done within 6 months. If the scan indicates participants risk of prostate cancer is low, they will not have a biopsy. All participants will be followed for 5 years. They and/or their local doctors will be contacted once a year for follow-up. Additional mpMRIs may be recommended. ...

Detailed Description
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Background: Prostate cancer (PCa) is the most common non-dermatologic malignancy among American men and is a leading cause of cancer mortality. Men of African Ancestry (AA) have a 1.8- fold higher incidence of prostate cancer and a 2.2-fold higher likelihood of death when compared to men of European Ancestry. The predominant factor in the increased death rate is the increased incidence of cancer. The underlying reasons for the increase in incidence are controversial but likely include genetic and environmental factors. One strategy to counteract the effects of increased cancer incidence in a given patient population is to utilize earlier and/or more intense screening as it leads to earlier diagnosis and potentially better outcomes. Multiparametric MRI (mpMRI) is a proven useful tool in the diagnosis of prostate cancer but access to high quality mpMRI in communities of color is often limited. For individuals who are members of communities of color, high quality prostate MRI is a limited resource and insurance coverage is often denied. Given the high risk of prostate cancer in these communities, the benefits of screening with mpMRI and mpMRI guided biopsies could be significant as it could enable earlier diagnosis. Objective: -To compare results of mpMRI and mpMRI guided biopsy in diagnosing clinically significant prostate cancer between men of African Ancestry from hospitals providing medical care for communities of color (e.g., Howard University Hospital, Washington Hospital Center) with the population of self-referred participants seen at NIH who are mostly of European Ancestry. Eligibility: Age >35 years Self-identified men of African Ancestry Elevated serum prostate specific antigen (PSA) of >=3ng/ml and/or positive digital rectal examination and/or strong family history of cancer Design: This is a prospective single arm observational study. Up to 345 prostate biopsy na(SqrRoot) ve participants will be recruited to evaluate the use of mpMRI and mpMRI guided biopsy in diagnosing localized clinically significant prostate cancer among men of African Ancestry. Study participants will be referred by hospitals that mainly provide medical care for communities of color (e.g., Howard University Hospital, Washington Hospital Center). Participants will undergo a state-of-the-art mpMRI of the prostate in the Molecular Imaging Branch, NCI. If a suitable lesion (Prostate Imaging Reporting and Data System (PI-RADS >=3) is identified, mpMRI/transrectal ultrasound (TRUS) fusion guided and standard of care systematic TRUS guided biopsies of the prostate will be performed within 6 months after the mpMRI. Participants with no PI-RADS score >=3 lesions at baseline mpMRI will not have a biopsy but will be followed for 5 years. Participants with a positive baseline mpMRI will be in follow-up for 5 years and have phone/virtual visits occurring annually. Prostate cancer related records and overall 5 year survival status of the participants will be monitored during these follow up visits. If clinically indicated and per referring physician, additional follow up MRIs and PSAs may be obtained annually or bi-annually.

Official Title
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Observational Study of Rates of Prostate Cancer Diagnosis in Men of African Ancestry Using MRI and MRI Guided Biopsy

Conditions
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Prostate Specific Antigens, Positive Digital Rectal Examination, Strong Family History of Prostate Cancer, Prostatic Neoplasms

Participation Criteria
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Eligibility Criteria
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INCLUSION CRITERIA: Age >35 years. Men self-identified as being of African Ancestry. Elevated serum prostate specific antigen of >=3ng/ml and/or positive digital rectal examination and/or strong family history of prostate cancer (at least 1 first or second degree male relative). ECOG performance status <=2. Ability of participant to understand and the willingness to sign a written informed consent document. Must be co-enrolled in protocols 16-C-0010 and/or 18-C-0017. EXCLUSION CRITERIA: Prior prostate biopsy. Prior radiotherapy or surgery for prostate cancer. Prior or ongoing hormonal therapy or chemotherapy (e.g., docetaxel) for prostate cancer. Participants unwilling or unable to undergo MRI, including participants with contraindications to MRI. Participants unwilling or unable to undergo biopsy, including participants with contraindications to biopsy.

Ages Eligible for Study
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Minimum Age: 35 Years
Maximum Age: 120 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cohort 1<br>Participants of African Ancestry with elevated serum prostate specific antigen of (Bullet)3ng/ml or positive digital rectal examination or strong family history. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cancer detection rate | To compare results of mpMRI and mpMRI guided biopsy in diagnosing clinically significant prostate cancer between men of African Ancestry (AA) from hospitals providing medical care for communities of color (e.g., Howard University Hospital, Washington Hospital Center) with the population of self-referred participants seen at NIH who are mostly Caucasian. | mpMRI performed at baseline visit 1 and mpMRI guided biopsy performed within 6 months after that in participants with PI-RADS score >=3. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Provide a summary of the report to local health insurance companies | To provide data to insurers that supports reimbursement of MRI in men of African Ancestry in order to improve access to care. | End of study | 
| Sensitivity and Area under the curve (AUC) | To use and further develop artificial intelligence (AI) algorithms to predict for clinically significant prostate cancer in men of African Ancestry based on MRI and clinical features as well as genomic risk scores. | Study duration | 
| Prostate cancer status and overall survival in mid-term (5 years) follow up | To evaluate prostate cancer status and overall survival in mid-term (5 years) follow up course after baseline MRI | 5 years | 
| Genomic sequencing findings | To evaluate genomic sequencing of diagnosed tumors in men of African Ancestry and compare it to the population of self-referred participants to the NCI which is predominantly Caucasian. | Baseline visit 1 and visit 2. | 
| Polygenic risk score | To evaluate the predictive value of the polygenic risk score (PRS) in predicting clinically significant prostate cancer in men of African Ancestry. | Study duration | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Health Disparity, Multiparametric MRI, MRI-Guided Biopsy, Prostate Cancer