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Using Multiparametric MRI to Evaluate Intraprostatic Tumor Responses and Androgen Resistance Patterns in Newly Diagnosed Prostate Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02430480
Recruitment Status : Active, not recruiting
First Posted : April 30, 2015
Last Update Posted : August 16, 2019
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) )

Brief Summary:


  • There are several ways to treat prostate cancer. Researchers want to see how well a certain kind of imaging helps detect prostate cancer. They also want to see if a particular drug combination used before surgery will benefit people with prostate cancer that hasn t spread in the body (non-metastatic). The combination will be androgen deprivation therapy and enzalutamide.
  • The combination of androgen deprivation therapy and enzalutamide has been shown to make patients with advanced (metastatic disease) live longer. The investigators want to see if using it earlier can increase cure rate of surgery and identify genetic or molecular characteristics that are associated with better outcomes.


- To develop better ways of detecting prostate cancer before and after pre-operative treatment.


- Men at least 18 years old with non-metastatic prostate cancer. They must be candidates for a radical prostatectomy.


  • Participants will be screened with medical history, physical exam, and blood tests. They will have scans and X-rays.
  • Before starting the study drugs, participants will have:
  • Vital signs taken, medical history, and blood tests.
  • ECG heart test, with patches stuck on the skin.
  • Small piece of tumor removed (biopsy) using image guidance from MRI and ultrasound.
  • 3T mpMRI. Participants will lie on a table that slides into a metal cylinder. A probe will be inserted in the <TAB>rectum. They will be in the scanner for about 60 minutes, lying still. The scanner makes loud knocking <TAB>sounds. Participants will get earplugs.
  • Participants will take the 2 study drugs for 6 months.
  • Enzalutamide is taken as 4 pills once a day.
  • Androgen deprivation therapy is given by injection 2 times over 6 months.
  • During these 6 months, participants will visit the clinic monthly. They will have physical exam, vital signs, and blood drawn.
  • After finishing the study drugs, participants will have another 3T mpMRI. Then they will have prostate removal surgery.

Condition or disease Intervention/treatment Phase
Prostate Cancer Drug: Goserelin Drug: Enzalutamide Procedure: mpMRI Phase 2

Detailed Description:


  • Most men diagnosed with prostate cancer will present with intermediate or high-risk disease
  • Many develop castrate resistant prostate cancer (CRPC) as curative strategies are often


  • Treatment options typically involve radical prostatectomy (RP) or radiation therapy (RT) in combination with androgen deprivation therapy (ADT)
  • Even when cancers are initially sensitive to ADT, resistance ultimately emerges either through clonal selection or through a variety of adaptive mechanisms (secondary resistance).
  • The recent introduction of novel androgen pathway inhibitors offers an opportunity to potentially improve the cure rate of men with intermediate and high risk localized prostate cancer
  • There remains a great need for improved techniques to determine mechanisms of treatment response and resistance.


-To test the feasibility of multi parametric magnetic resonance imaging (mpMRI) for the localization and detection of focal prostate cancer both before and after pre-operative treatment with ADT and enzalutamide.


  • Patients with nonmetastatic castration sensitive prostate cancer with intermediate or high-risk features
  • Patients with testosterone levels greater than or equal to 100 ng/dL.
  • ECOG 0-1.


  • Patients will be treated with ADT and enzalutamide for 6 months
  • Two 3T mpMRI endorectal examinations (One at screening and after 6 month of treatment)
  • Screening biopsy (MR/US guided) samples
  • Standard of care prostatectomy (RP) following post treatment mpMRI
  • All tumor specimens will undergo genomic analysis

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 38 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Neoadjuvant Androgen Deprivation and Enzalutamide: Using Multiparametric MRI to Evaluate Intraprostatic Tumor Responses and Androgen Resistance Patterns in Newly Diagnosed Prostate Cancer
Actual Study Start Date : June 3, 2015
Estimated Primary Completion Date : December 1, 2019
Estimated Study Completion Date : June 1, 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Prostate Cancer

Arm Intervention/treatment
Experimental: 1/Arm 1
Patients will have an mpMRI guided biopsy, then receive enzalutamide and goserelin SC treatment for 6 months followed by a second mpMRI examination.
Drug: Goserelin
10.8mg administered subcutaneously every 12 weeks (2 doses)

Drug: Enzalutamide
160mg orally, daily for 24 weeks

Procedure: mpMRI
Multiparametric MRI - One at baseline and after 6 months of treatment

Primary Outcome Measures :
  1. Feasiblity of mpMRI before and after surgery [ Time Frame: 6 months ]
    localization and detections of focal prostate cancer before and aftertreatment with mpMRI

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
  • Patients must have histologically or cytologically confirmed prostate cancer confirmed by the Laboratory of Pathology, NCI or Pathology Department at Walter Reed Bethesda
  • Must have previously untreated (with definitive therapy) prostate cancer with intermediate or high risk features defined as:

    • Intermediate risk:

      • PSA level is between 10 and 20 ng/ml or
      • Gleason score is 7 or
      • Stage T2b or T2c
    • High Risk:

      • Gleason 8 and higher OR
      • PSA greater than 20 at the time of diagnosis OR
      • Seminal vesicle involvement OR
      • Possible (on MRI) Extra-capsular extension (T3 disease)
  • Patients must be eligible for and must be planning to undergo radical prostatectomy
  • Patients must have testosterone levels greater than or equal to 100 ng/dL
  • Men age greater than or equal to 18 years.

    • Children are excluded because prostate cancer is not common in pediatric populations.
    • Women are not eligible because this disease occurs only in men.
  • ECOG performance status less than or equal to 1
  • Patients must have normal organ and marrow function as defined below:
  • Hemoglobin greater than or equal to 9 g/dL
  • leukocytes greater than or equal to 3,000/mcL
  • absolute neutrophil count greater than or equal to 1,500/mcL
  • platelets greater than or equal to 150,000/mcL
  • total bilirubin within normal institutional limits
  • AST(SGOT)/ALT(SGPT) less than or equal to 3 X institutional upper limit of normal
  • creatinine within normal institutional limits


  • creatinine clearance greater than or equal to 60 mL/min/1.73 m2 for patients with creatinine levels above institutional normal.
  • The effects of enzalutamide on the developing human fetus are unknown. For this reason and because androgen receptor antagonists as well as other therapeutic agents used in this trial are known to be teratogenic, male participants and their female partners of child bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence). Male participants should use a condom if having intercourse with a pregnant woman. Additionally, a condom plus another effective method of birth control is recommended during therapy and for 3 months after treatment for male participants having intercourse with a woman of reproductive potential. Should a woman become pregnant or suspect she is pregnant while her partner is participating in this study, she should inform her treating physician immediately.
  • Ability of subject to understand and the willingness to sign a written informed consent document.
  • Willingness to undergo biopsy.
  • Ability to detect lesions within prostate on MRI for biopsy
  • Willingness to travel to NIH for follow-up visits.


  • Patients who are receiving any other investigational agents (in the past 28 days) or herbal medications (within 1 day).
  • Patients with distant metastatic disease beyond N1(regional) lymph nodes on conventional imaging studies (CT, MRI or Bone Scan).
  • Patients who have received any prior therapy for prostate cancer with surgery, radiation, and/or chemotherapy
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to enzalutamide or other agents used in study.
  • Clinically significant cardiac disease, e.g. New York Heart Association (NYHA) classes III-IV; uncontrolled angina, uncontrolled arrhythmia or uncontrolled hypertension, myocardial infarction in the previous 6 months as confirmed by an electrocardiogram (ECG).
  • Contraindication to biopsy:

    • Bleeding disorders
    • PT/PTT greater than or equal to 1.5 times the upper limit of normal
    • Artificial heart valve
  • Contraindication to MRI:

    • Patients weighing more than weight limit for the scanner tables
    • Allergy to MR contrast agent
    • Patients with pacemakers, cerebral aneurysm clips, shrapnel injury or implantable electronic device
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Patients with known HIV are eligible. These patients are at increased risk of lethal infections when treated with marrow-suppressive therapy. In addition, if patients are receiving combination antiretroviral therapy, there is potential for pharmacokinetic interactions with enzalutamide. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated.
  • Patients with known active treatment for Hepatitis B and C infections.
  • Patients who are taking medications that are strong inhibitors of CYP3A4 or PgP and need to remain on these medications. For a current table of Substrates, Inhibitors and Inducers please access the following website:

  • History of seizure, including any febrile seizure, loss of consciousness, or transient ischemic attack, or any condition that may pre-dispose to seizure (e.g., prior stroke, brain arteriovenous malformation, head trauma with loss of consciousness requiring hospitalization).
  • Other medications used for urinary symptoms including 5-alpha reductase inhibitors (finasteride and dutasteride) and alternative medications known to alter PSA (eg phytoestrogens and saw palmetto) cannot be taken while patients are receiving enzalutamide
  • Patients with a malignancy within the past 3 years for which study drugs or a prostatectomy is a contraindication.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02430480

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United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
National Cancer Institute (NCI)
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Principal Investigator: William L Dahut, M.D. National Cancer Institute (NCI)

Additional Information:
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: National Cancer Institute (NCI) Identifier: NCT02430480     History of Changes
Other Study ID Numbers: 150124
First Posted: April 30, 2015    Key Record Dates
Last Update Posted: August 16, 2019
Last Verified: August 12, 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) ):
Multiparametric MRI
Focal Prostate Cancer
Normal Testosterone
Non Metastatic
Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Genital Diseases, Male
Prostatic Diseases
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antineoplastic Agents, Hormonal
Antineoplastic Agents