1. A Phase 4 Open-Label Multicenter Study of Piflufolastat F 18 PET/CT or PET/MRI in Men with Newly Diagnosed Favorable Intermediate Risk Prostate Cancer: MIRROR.
- Author
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Tward, J.D., Josephson, D., Catana, C., Covington, M., Feldman, A.S., Purysko, A., Teslenko, I., Provost, J.C., An, H., Bilyk, R., Denes, B.S., Ulaner, G.A., and Carroll, P.
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LYMPHADENECTOMY , *SEMINAL vesicles , *POSITRON emission tomography , *RADICAL prostatectomy , *PROSTATE biopsy , *PROSTATE cancer - Abstract
The probability of nodal and distant metastasis in patients (pts) with very-low, low, and favorable intermediate risk (FIR) prostate cancer (PCa) is considered low. Current NCCN and AUA/ASTRO guidelines do not recommend PSMA PET staging for these men. However, it has been reported that pts assigned to the FIR category are more likely than low-risk pts to have adverse pathological findings (upstaging and upgrading) at radical prostatectomy (RP) with a trend toward shorter recurrence-free survival. Early detection of clinically significant disease, extraprostatic extension, seminal vesicle invasion, N1 or M1 disease may change medical management in FIR pts and improve treatment outcomes. The purpose of this study is to explore whether piflufolastat F 18 PET/CT or PET/MR can detect higher risk disease in men previously assessed as FIR by standard of care methods. We hypothesize that piflufolastat F 18 PET will detect non-organ confined disease or upgrade pts to International Society of Urologic Pathologists (ISUP) grade ≥3 PCa in at least 5% of FIR subjects. This trial will also assess the ability for PET to better assess the volume and extent of the intraprostatic cancers. MIRROR is a phase 4, open label single arm multicenter study designed to evaluate the diagnostic performance and safety of piflufolastat F 18 in men with newly diagnosed FIR PCa. Eligible male pts must be ≥18 years of age, no prior PCa treatment, have a life expectancy of at least 13 months as determined by investigator, and confirmed FIR PCa per 2023 NCCN guidelines. The date of the prostate biopsy should be no sooner that 2 weeks and no later than 3 months prior to piflufolastat F 18 PSMA PET imaging. Participants will receive a single dose of piflufolastat F 18 injection followed by a single PET/CT or PET/MRI from mid-thigh through skull vertex acquired at 1 to 2 hours post-injection. Pts with a positive study scan results suspicious for PCa ISUP grade ≥3 or non-organ confined disease may be asked to undergo additional diagnostic test(s) for PCa and/or RP with pelvic lymph node dissection within 2 to 90 days after study scan to determine a truth standard. Pts will be monitored for up to 12 months to collect information about PCa treatment decisions and PSA results. The primary objective is to determine the detection rate defined as the proportion of participants with PCa in whom piflufolastat F 18 PET detected intraprostatic ISUP grade ≥3 lesions as confirmed by pathology, or in whom piflufolastat F 18 PET detected the presence of either/or extraprostatic extension, seminal vesicle invasion, regional lymph node involvement, distant metastases. Additional objectives include: change in intended patient clinical management, correct localization rate, true detection rate, sensitivity, specificity, PPV & NPV against reference standard. The study is currently open in the US. NCT06074510 TBD. TBD. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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