1
|
Bagguley D, Harewood L, McKenzie D, Ptasznik G, Ong S, Chengodu T, Woon D, Sim K, Sheldon J, Lawrentschuk N. The CONFIRM trial protocol: the utility of prostate-specific membrane antigen positron emission tomography/computed tomography in active surveillance for prostate cancer. BJU Int 2024; 133 Suppl 4:27-36. [PMID: 37904302 DOI: 10.1111/bju.16214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
OBJECTIVES Primary objectives: To determine the additive value of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in the risk stratification of men with newly diagnosed prostate cancer (PCa) who would have otherwise been deemed suitable for active surveillance (AS). Specifically, we aim to determine if PSMA PET/CT can detect a cohort of men on AS that are in fact high risk and likely to experience unfavourable outcomes should they remain on their current treatment pathway. SECONDARY OBJECTIVES to determine the additive value of PSMA PET/CT to repeat multiparametric magnetic resonance imaging (mpMRI) of the prostate and explore whether a confirmatory biopsy may be avoided in men with a negative PSMA PET/CT and a negative repeat mpMRI of the prostate (Prostate Imaging-Reporting and Data System score of <3). Furthermore, to develop a nomogram combining clinical, imaging and biomarker data to predict the likelihood of failure on AS in men with high-risk features. Also, a blood sample will be taken to perform a Prostate Health Index test at the time of confirmatory biopsy. Furthermore, a portion of this blood will be stored at a biobank for up to 5 years if a follow-up study on molecular biomarkers and genetic assays in this cohort of men is indicated, based on the results from the CONFIRM trial. PATIENTS AND METHODS The CONFIRM trial is a prospective, multicentre, pre-test/post-test, cohort study across Victoria, Australia, involving men with newly diagnosed low-risk PCa with high-risk features, considered suitable for AS and undergoing confirmatory biopsy. The trial's goal is to provide high-quality evidence to establish whether PSMA PET/CT has a role in risk-stratifying men deemed suitable for AS despite having high-risk feature(s). RESULTS The CONFIRM trial will measure the proportion of men deemed unsuitable for ongoing AS based on pathological upgrading and multidisciplinary team recommendation due to PSMA PET/CT scan and PSMA-targeted confirmatory biopsy. Additionally, the positive and negative predictive values, sensitivity, and specificity of PSMA PET/CT will be calculated in isolation and combined with repeat mpMRI of the prostate. CONCLUSIONS This trial will provide robust prospective data to determine if PSMA-PET/CT and standard of care (prostate biopsy ± repeat mpMRI) can improve diagnostic certainty in men undergoing confirmatory biopsy for low-grade PCa with high-risk features.
Collapse
Affiliation(s)
- Dominic Bagguley
- EJ Whitten Foundation Prostate Cancer Research Centre at Epworth, Richmond, Victoria, Australia
| | - Laurence Harewood
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
- Urology Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Dean McKenzie
- Research Development and Governance Unit, Epworth HealthCare, Richmond, Victoria, Australia
- Health Sciences and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Gideon Ptasznik
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Young Urology Research Organisation, Melbourne, Victoria, Australia
| | - Sean Ong
- EJ Whitten Foundation Prostate Cancer Research Centre at Epworth, Richmond, Victoria, Australia
| | | | - Dixon Woon
- Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, Victoria, Australia
| | - Kenneth Sim
- Epworth Medical Imaging, Freemasons Hospital, Melbourne, Victoria, Australia
| | - James Sheldon
- Epworth Medical Imaging, Freemasons Hospital, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- EJ Whitten Foundation Prostate Cancer Research Centre at Epworth, Richmond, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
- Urology Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Research Development and Governance Unit, Epworth HealthCare, Richmond, Victoria, Australia
| |
Collapse
|
2
|
La J, Katz DJ. Linking COVID-19 Vaccine and Male Infertility - Not on Fertile Ground. BJU Int 2022; 130 Suppl 1:20-21. [PMID: 35182404 PMCID: PMC9111670 DOI: 10.1111/bju.15712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/04/2022] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Justin La
- Men's Health Melbourne, Victoria, Australia.,Department of Urology, Western Health, Victoria, Australia
| | - Darren J Katz
- Men's Health Melbourne, Victoria, Australia.,Department of Urology, Western Health, Victoria, Australia.,Department of Surgery, Western Precinct, University of Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Ip CCK, Kealey J, Davis ID, Sengupta S. Impacts of the COVID-19 pandemic on early detection of prostate cancer in Australia. BJU Int 2021; 128 Suppl 3:6-8. [PMID: 34750958 PMCID: PMC8653189 DOI: 10.1111/bju.15631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher C K Ip
- Department of Urology, Eastern Health, Box Hill, Vic., Australia.,Eastern Health Clinical School, Monash University, Melbourne, Vic., Australia
| | - Joshua Kealey
- Department of Urology, Eastern Health, Box Hill, Vic., Australia.,Eastern Health Clinical School, Monash University, Melbourne, Vic., Australia
| | - Ian D Davis
- Eastern Health Clinical School, Monash University, Melbourne, Vic., Australia.,Department of Medical Oncology, Eastern Health, Box Hill, Vic., Australia
| | - Shomik Sengupta
- Department of Urology, Eastern Health, Box Hill, Vic., Australia.,Eastern Health Clinical School, Monash University, Melbourne, Vic., Australia
| |
Collapse
|