An imaging-based pathway to risk stratify and treat radiorecurrent prostate cancer.
The name FORECAST stands for the ‘Focal Recurrent Assessment and Salvage Treatment’. Although radiotherapy is one of the standard treatments for men with prostate cancer many men do not respond. After radiotherapy most of these men will be started on hormone therapy and/or local ‘salvage’ treatments, which have aversive side effects including incontinence and impotence. These treatments do not have a high rate of success because the current tests (CT and bone scan) are not very good at revealing whether cancer recurrence is within the prostate or outside it, meaning that sometimes patients undergo unnecessary or delayed treatment. Also, it is difficult to treat irradiated prostates and there are many side-effects.
This study, led by Mr Hashim Uddin Ahmed and Professor Mark Emberton, will look at whether novel imaging (whole body MRI) can identify those men whose cancer has not spread, whether targeted biopsies to suspicious areas on imaging can give the same information as sampling the entire prostate and what the side effects are when only treating areas of cancer rather than the whole prostate. In doing so researchers hope to better identify men with no cancer spread to offer more targeted salvage focal therapy and improve outcomes for men with recurrent prostate cancer after radiotherapy.
Link to UKCRN.
Review of major adverse effects of androgen-deprivation therapy in men with prostate cancer.Taylor LG, Canfield SE and Du XL. Cancer. 2009; 115(11):2388-99
Focal Therapy for localised unifocal and multifocal prostate cancer; a prospective sevelopment study. Ahmed HU, Hindley RG, Dickinson L, Freeman A, Kirkham AP, Sahu M, Scott R, Allen C, Van der Meulen J, Emberton M. Lancet Oncol. 2012; 13(6): 622-32
Focal therapy for localized prostate cancer: a phase I/II trial. Ahmed HU, Freeman A, Kirkham A, Sahu M, Scott R, Allen C, Van der Meulen J, Emberton M. J Urol. 2011; 185(4): 1246-54
Characterizing clinically significant prostate cancer using template prostate mapping biopsy. Ahmed HU, Hu Y, Carter T, Arumainayagam N, Lecornet E, Freeman A, Hawkes D, Barratt DC, Emberton M. J Urol. 2001; 186(2): 458-64
Can whole-body magnetic resonance imaging with diffusion weighted imaging replace Tc 99m bone scanning and computed tomography for single-step detection of metastases in patients with high-risk prostate cancer? Le Couvet FE, El Mouedden J, Collette L et al. Eur Urol. 2012 Jul; 62(1): 68-75
Accuracy of multiparametric magnetic resonance imaging in detecting recurrent prostate cancer after radiotherapy.Arumainayagam N, Kumaar S, Ahmed HU et al. British Journal of Urology International. 2010; 106: 991-997