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Pathways to Discovery: Winter 2013

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MR-Guided Focal Laser Ablation Shows Promise for Prostate Cancer Treatment

Investigators at the UCCCC are developing a new method that combines magnetic resonance (MR) imaging with a technique called focal laser ablation to treat low-risk prostate cancer precisely. If proven effective, the technique may offer patients a safe, new treatment option.

Prostate Cancer Detection
A longstanding issue in prostate cancer, the second-leading cause of cancer deaths in American men, is the method by which patients are diagnosed. Based on abnormal results of a prostate-specific antigen (PSA) exam, patients typically undergo a biopsy to sample tissues from different areas of the prostate gland using ultrasound guidance. Often, repeat biopsies are needed to confirm a diagnosis.

In May, the U.S. Preventive Services Task Force discouraged PSA screening, concluding that screening may be harmful due to “false-positive” results and overtreatment of cancers that would not have caused future health issues.

“Most people who are diagnosed with prostate cancer will not die of the disease, but there’s no perfect way to differentiate between deadly and non-deadly cancers,” said Aytekin Oto, MD, professor of radiology and surgery. He explained that treatment options range from surgical removal of the entire prostate, which carries a 5-10% chance of incontinence and up to 30% chance of impotence, to active surveillance, a strategy of ”keeping a close eye” on the cancer with the goal of never requiring treatment but intervening in the future, if needed.

A Less Aggressive Treatment Option
UCCCC researchers are evaluating new methods to detect aggressive cancers more accurately, which have the potential to spare patients with indolent cancers from unnecessary biopsies, surgeries, and treatments while simultaneously identifying men with large or aggressive cancers who are most likely to benefit from treatment. Researchers are also pursuing image-guided focal treatment methods to expand existing therapeutic options.

“We’re looking for better ways to determine who benefits from treatment and who could be safely observed or undergo focal therapy––that’s really the ‘Holy Grail’ of prostate cancer research,” said Scott Eggener, MD, associate professor of surgery. Focal laser ablation therapy is a minimally invasive treatment that precisely targets and destroys the cancer.

Drs. Oto and Eggener teamed up to develop a Phase I clinical trial to evaluate the feasibility and safety of using MR-guided focal laser ablation therapy to treat clinically low-risk prostate cancer. Combining these two technologies is advantageous because MR imaging guidance facilitates direct visualization and targeting of prostate tumors in real-time.

Dr. Oto compared the procedure to lumpectomy for breast cancer, where surgeons remove the cancer instead of the whole breast. “The goal of focal ablation is to effectively treat the cancer without serious complications,” he said.

Nine patients with low-risk prostate cancer were treated without significant complications. After one year of follow up, residual cancer was detected in two patients––the other seven remained cancer-free. Because the Phase I trial successfully demonstrated the safety of the procedure, the researchers are initiating a Phase II trial in early 2013 to evaluate the effectiveness of focal therapy in controlling low risk prostate cancer.

Dr. Oto is hopeful that the research will change the paradigm for prostate cancer therapy, presenting an alternative to more aggressive treatment options. “With this focal treatment method, we hope to one day tell our patients that we’re taking care of their cancer without risk of serious complications,” he said. “That will be a huge service to them.”

Ernst Lengyel