AMERICAN COLLEGE OF RADIOLOGY IMAGING NETWORK ACRIN 6659 MR IMAGING AND MR SPECTROSCOPIC IMAGING OF PROSTATE CANCER PRIOR TO RADICAL PROSTATECTOMY: A PROSPECTIVE MULTI-INSTITUTIONAL CLINICOPATHOLOGICAL STUDY Principal Investigator Jeffrey C. Weinreb, MD PARTIAL PROTOCOL— Chief of MRI, Professor of Radiology CONTACT ACRIN Yale University School of Medicine PROTOCOL Department of Radiology DEVELOPMENT AND 333 Cedar St., Room MRC 147 REGULATORY New Haven, CT 06520 COMPLIANCE FOR A Phone: 203-785-5913 Fax: 203-785-3061 COMPLETE PROTOCOL E-mail: [email protected] Spectroscopy Advisor Co-Principal Investigator John Kurhanewicz, PhD Fergus V. Coakley, MB BCh Magnetic Resonance Science Center Chief, Abdominal Imaging Section Department of Radiology Department of Radiology University of California San Francisco University of California, San Francisco 1 Irving Street, AC109 Box 0628, L-308, 505 Parnassus Ave. San Francisco, CA 94143-1290 San Francisco, CA 94143-0628 Phone: 415-476-0312 Phone: 415-353-1786 Fax: 415-476-8809 Fax: 415-476-0616 E-mail: [email protected] E-mail: [email protected] Pathology Advisor Statistical Advisor Thomas Wheeler, MD Jeffrey Blume, PhD The Methodist Hospital Center for Statistical Sciences Deputy Chief / Pathology Service Brown University, Box G-H 6565 Fannin, MS 205 Providence, RI 02912 Houston, TX 77030 Phone: 401-863-9968 Phone: 713-394-6475 Fax: 401-863-9182 Fax: 713-793-1603 E-mail: [email protected] E-mail: [email protected] Version Date: July 16, 2003 Activation Date: June 23, 2003 Including amendments #1-5 This protocol was designed and developed by the American College of Radiology Imaging Network (ACRIN). It is intended to be used only in conjunction with institution-specific IRB approval for study entry. No other use or reproduction is authorized by ACRIN, nor does ACRIN assume any responsibility for unauthorized use of this protocol. 6659 7/16/03 INDEX Schema 1.0 Abstract..................................................................................................................................1 2.0 Background and Significance ................................................................................................1 3.0 Specific Aims or Objectives ..................................................................................................8 4.0 Study Overview.....................................................................................................................8 5.0 Patient Selection.....................................................................................................................8 6.0 Site Selection.........................................................................................................................9 7.0 Online Registration System ...................................................................................................9 8.0 Data Collection and Management..........................................................................................10 9.0 Data Collection Forms ...........................................................................................................13 10.0 Pathology and Image Submission..........................................................................................13 11.0 Imaging Modalities ................................................................................................................15 12.0 Statistical Considerations REMOVED FROM WEB VERSION ..............................................18 13.0 Adverse Event Reporting …………………………………………………………………… 18 14.0 Institutional Audits ………………………………………………………………………… 19 References.......................................................................................................................................... 22 Appendix I: Sample Consent Form................................................................................................ 25 Appendix II: Tissue Banking Consent ........................................................................................... 31 Appendix III: Eligibility Checklist ................................................................................................... 33 Appendix IV: Protocol Specific Application.................................................................................... 36 Appendix V: Diagram of the Prostate……………………………………………………………. 37 Appendix VI: QA Spectroscopy SNR Protocol …………………………………………………… 38 Appendix VII: Procedure To Set Up the Prostate Exams Under Functool 2 ……………………. 42 Appendix VIII: MRS/Imaging Test Case Submission and Approval Process…………………… 44 6659 7/16/03 AMERICAN COLLEGE OF RADIOLOGY IMAGING NETWORK ACRIN 6659 MR IMAGING AND MR SPECTROSCOPIC IMAGING OF PROSTATE CANCER PRIOR TO RADICAL PROSTATECTOMY: A PROSPECTIVE MULTI-INSTITUTIONAL CLINICOPATHOLOGICAL STUDY SCHEMA R E G Pre-operative MRI/MRSI Radical Prostatectomy (within six months of imaging studies): Pathologic review I ( ≥ 6 weeks post-biopsy) Surgery to be performed at surgical institution followed by a central review by S Dr. Thomas Wheeler T E R The primary objective of this study is to compare the diagnostic accuracy of MRI versus MRI combined with MRSI (called just MRSI hereafter) for the localization of prostate cancer in patients who are scheduled to have radical prostatectomy surgery. Reference information will be decided from the pathological examination of surgical specimens. Five core institutions will participate with a single reader at each institution; each reader will evaluate every participant on study regardless of institutional affiliation. Eligibility: (See Section 5.0 for details) - Biopsy-proven adenocarcinoma of the prostate. - The patient is expected to undergo a radical prostatectomy at the participating institution within six (6) months of MRI/MRSI imaging. - Interval between biopsy and protocol MRI/MRSI must not be less than six (6) weeks. - Pathologic specimens from surgery must be provided for central analysis. - Signed study-specific consent form prior to study entry. - Consent to the administration of Fleet enema as part of preparatory procedures. - Encourage retrieval of any outside biopsy reports and slides (medical release form with signature) Required Sample Size: 134 patients to be recruited in seven (7) months 6659 7/16/03 1.0 ABSTRACT Endorectal MRI is emerging as the most accurate modality for the local imaging of prostate cancer. MR spectroscopic imaging (MRSI) of the prostate depicts the altered metabolism associated with prostate cancer, and is performed in conjunction with standard endorectal MRI. Combined endorectal MRI and MRSI provides an integrated anatomic and metabolic depiction of prostate cancer, and appears superior to endorectal MRI alone. The primary aim of this protocol is to evaluate the accuracy of combined MRI/MRSI performed at multiple institutions in the localization of prostate cancer and its incremental benefit on diagnostic accuracy when compared to MRI alone. One hundred and thirty-four patients with documented prostate cancer who are planned for radical prostatectomy will undergo preoperative combined MRI/MRSI at 1 of 5 institutions. Five independent readers will interpret all scans. Reference information will be derived from central pathological examination of surgical specimens. Secondary objectives include determination of the incremental effect of combined MRI/MRSI on inter-observer agreement when compared to MRI alone and determination of the accuracy of combined MRI/MRSI when compared to other available information on tumor extent derived from digital rectal examination, prostate specific antigen (PSA) level, Gleason score, and Partin nomogram. 2.0 BACKGROUND AND SIGNIFICANCE 2.1 Medical and Socioeconomic Importance of Prostate Cancer Prostate cancer is the most common non-cutaneous cancer and the second most common cause of cancer death in American men. In 1999, an estimated 179,300 new cases of prostate cancer were diagnosed in the United States, and an estimated 37,000 men died of the disease.1 For 2001, 198,000 new cases are predicted. The rise in prostate cancer incidence appears partially due to an increase in screening with digital rectal examination (DRE), prostate-specific antigen (PSA), and transrectal ultrasonography (TRUS) with biopsy.2-5 However, the age-adjusted mortality rose an estimated 39% from 1985 to 1997,5 suggesting both a true increase in clinically important disease in addition to an increase in diagnostic sensitivity. Combined with an aging population, these factors have made prostate cancer a major medical and socioeconomic problem. 6659 1 7/16/03 2.2 Staging of Prostate Cancer Both the TNM and Jewett-Whitmore staging systems are in common usage, and are based on the local, nodal, and distant extent of disease (AJCC, Jewett manual).6,7 The staging systems are summarized below: Jewett- TNM Description Whitmore A I (T1N0M0) Organ-confined tumor. Clinically and radiologically inapparent. B II (T2N0M0) Organ-confined tumor. Clinically or radiologically apparent. T2A: Unilateral T2B: Bilateral C III (T3N0M0) Extracapsular extension, or seminal vesicle invasion. T3A: Extracapsular extension T3B: Seminal vesicle invasion D* IV Distant spread. (T4, N1, or M1) T4: Invasion of the bladder, external sphincter or rectum N1: Regional nodal metastases M1A: Non-regional nodal metastases M1B: Bony metastases M1C: Other distant metastases *The Jewett-Whitmore classification divides stage D into D1 (microscopic nodal metastases only) and D2 (all other forms of distant