“Image-directed therapy for prostate cancer – the challenges ahead.”
In May 2008 an international group of surgeons, radiologists, oncologists, scientists and patient representatives met to discuss tumour imaging as an accurate means of characterising and mapping the true volume and extent of prostate cancer. They concluded that contemporary tumour imaging technologies have the potential to change the way prostate disease is both evaluated and treated.
The meeting received reports of research from the UK, the USA and France that identify 1.5T magnetic resonance imaging (MRI) as currently the most effective and widely available imaging method to detect, pin-point and help quantify tiny zones of cancerous tissue in the prostate.
According to meeting chairman, Mr Mark Emberton (now Professor Emberton), Reader in Interventional Oncology, University College London (UCL), non-invasive imaging could help cut down on repeated tissue biopsies, prevent over-aggressive surgical approaches to treatment and so help reduce much of the unnecessary morbidity associated with current prostate cancer surveillance and management.
The meeting delegation plans to form a steering group to help integrate imaging into the routine clinical management of prostate cancer. This led to the PROMIS trial – link to UKCRN page. It believes that a programme of clinical research, together with educational guidance and support for standardised reporting of imaging data, will allow prostate tumour imaging to play a major part in cancer management.
Other papers on the various challenges and therapies involved in treating prostate cancer were presented. The group also discussed staging and distinguishing between men with advanced disease and those with low volume, non-metastatic disease, is how best to manage patients with low volume disease.
Options for treatment such as focal therapy, a move away from radical therapy, that will ablate only parts of the prostate considered affected by clinically significant cancer, or active surveillance – involving regular assessments and tests for disease progression. Focal therapy ablates discrete areas of known cancer in the prostate and can offer men a treatment option to control disease while preserving maximal amounts of healthy tissue
- Focal Therapy Hashim Uddin Ahmed
- HIFU Hashim Uddin Ahmed
- MRI Urologists Perspective
- MRI Mark Emberton
- Other Modalities Rowland Illing
- Prostate MRI – Against the motion Dr Aslam Sohaib
- Photodynamic Therapy Ms Caroline Moore
- Global Treatment Omar Karim
- Visually directed high-intensity focused ultrasound for organ-confined prostate cancer: a proposed standard for the conduct of therapy Rowland O. Illing, Tom A. Leslie, James E. Kennedy, Jogn G. Calleary, Christopher W. Ogden, Mark Emberton, 2006 BJU International 98, pp 1187-1192
- `To what extent does the prostate-specific antigen nadir predict subsequent treatment failure after transrectal high-intensity focused ultrasound therapy for presumed localized adenocarcinoma of the prostate?` Toyoaki Uchida, Rowland O. Illing, Paul J. Cathcart, Mark Emberton, 2006 BJU International, 98, pp 537-539
- The effect of neoadjuvant androgen suppression on prostate cancer-related outcomes after high-intensity focused ultrasound therapy Toyoaki Uchida, Rowland O. Illing, Paul J. Cathcart, Mark Emberton, 2006 BJU International, 98, pp 770-772
- `How Good is MRI at Detecting and Characterising Cancer within the Prostate?` Alexander P.S. Kirkham, Mark Emberton, Clare Allen, European Eurology 50 (2006), pp 1163-1175.
- Letter in response to: Villers A, Puech P, Mouton D, Leroy X, Ballereau C, Lemaitre L. Dynamic Contrast Enhanced, Pelvic Phased Array Magnetic Resonance Imaging of Lolcalized Prostate Cancer for Predicting Tumour Volume: Correlation with Radical Prostatectomy Findings. Ahmed HU, Illing RO, Calleary J, Arya M, Allen C, Emberton M. J UROL 176: 2432-2437, 2006.