New trial for Prostate Cancer Staging
Last week Brisbane patients at the Wesley Hospital were the first to be involved in the latest trial for staging prostate cancer. The trial is focused on detection of the spread of prostate cancer outside of the prostate to lymph nodes.
The “Staging” of Prostate Cancer
When a patient is diagnosed with prostate cancer their surgeon will order medical imaging scans called “staging investigations” to see if the cancer has spread outside the prostate. This is important information to know prior to discussing treatment options. Prostate cancer usually spreads first to the lymph nodes in the pelvis and body cavity or the bones of the pelvis, femurs and spine. However, overall nowadays it is rare for patients to be diagnosed with spread outside the prostate, especially if the prostate specific antigen level measured by a blood test (PSA) is lower than 20. If there is no spread outside the prostate then patients have the option of choosing surgery or radiotherapy as curative treatment options.
The current problem surgeons have is knowing for sure whether a prostate cancer has spread to the lymph nodes prior to treatment. If they suspect it has, they will often remove the lymph nodes during removal of the prostate at surgery. This is done for two reasons – to better “stage” the cancer, or know how aggressive it is and where it has spread to; and secondly in the hope that if as many lymph nodes are removed as it is safe to do, that all the nodes containing cancer have also been removed and that the patient might be cured. However, the surgery is not without risk and adds more time to the operation. Furthermore, over 85% of patients having the lymph nodes removed have no cancer found in the lymph nodes. In other words, removing the lymph nodes was not necessary for treating the cancer, but the surgeon had no sure way of knowing this prior to performing the surgery.
PSMA-PET scanning has been found to detect more suspicious lymph nodes and bone lesions than other types of PET using other tracers. PSMA-PET can still be “wrong” sometimes and miss cancer in a lymph node, or fail to detect cancer in small nodes.
Another emerging imaging technique involves the use of small iron nano-particles bonded to sugar which are injected into the bloodstream followed by an MRI. This is called MRI nano-lymphography and the compound of iron-sugar is known by its commercial name – “Combidex”. The advantage of the Combidex MRI is that it can detect cancer in very small lymph nodes, down to 2mm in size, which is beyond the resolution of PET-PSMA as far as we know.
The ‘Magnifi’ trial (Metastasis assessment with Gallium-68 PSMA and Nanoparticle Imaging Fusion International)
The Magnifi trial will assess the concordance, both individual and combined, of PSMA-PET/CT and Combidex MRI nano-lymphography for the detection of the spread of prostate cancer outside of the prostate to lymph nodes in patients with intermediate to high risk prostate cancer. This trial is an International Multi centre trial involving the Wesley Hospital, Brisbane, Garvan at St Vincent’s in Victoria and Radboud Medical Centre in the Netherlands.
Collaboration is the Key!
The Wesley Hospital is well recognised as a Prostate Centre of Excellence. The combination of sophisticated diagnostics, advanced treatment options and rigorous standards has reinforced it’s position on the world stage. Their commitment and contribution to research and emerging prostate treatments has been a collaborative effort by the urologists and radiologists of the Wesley Hospital for many years. Together they have embarked on another trial in efforts to offer better care and hope for patients and their families effected by prostate cancer. The trial is lead by Principle Investigator Dr Nick Brown and supported by Dr Darren Ault and A/Prof David Wong of Uniting Care Medical Imaging. The success of this trial is heavily dependent upon the combined efforts of a dedicated group of specialists and a collaborative multi-disciplinary approach. The expertise and commitment from the Garvin Institute, Radboud University and the Wesley Hospital Uro-radiology group provides the foundation for another successful trial in the pursuit of better outcomes for men suffering with Prostate Cancer.
Associate Investigators include:
Dr Geoff Coughlin : Urologist Wesley Urology Clinic Brisbane
Professor Jelle Barentsz: Radiologist Radbound University Medical Centre The Netherlands
Professor Phillip Stricker: Urologist Garvan St Vincent’s Hospital Melbourne
Associate Professor Louise Emmett: Nuclear Medicine Radiologist Garvan St Vincent’s Hospital Melbourne
The Magnifi trial is funded by Uniting Care Medical Imaging and Wesley Medical Research