Improving the Diagnosis and Treatment of Localised Prostate Cancer
Lead Research Organisation:
University College London
Department Name: Surgery
Abstract
The way we diagnose prostate cancer at the moment is flawed. At present, a blood test called the prostate specific antigen, or PSA, is used to decide who gets a prostate biopsy. Prostate biopsy is painful, causes bleeding and sometimes serious infections. It often detects harmless cancers that need no treatment and misses important cancers that do. This is because prostate biopsies are random - we cannot see the cancer so needles are fired into the prostate in the hope that we will hit the cancer.
Once diagnosed, the way we treat early prostate cancer can cause a lot of harm. Current treatments for early prostate cancer target the whole prostate, causing damage to surrounding structures. This can lead to urine leak, poor erections and back passage problems.
The research
I will test the ability of several markers in blood and urine as well as imaging to accurately predict the presence or absence of important prostate cancer.
I will also test whether treating the cancer only, in order to avoid damaging surrounding structures, is effective in cancer control and whether the harms of whole-gland treatments can be reduced.
The possible benefits
Reduce the number of men who undergo unnecessary prostate biopsy
Reduce the risk of being diagnosed with a harmless prostate cancer
Improve the diagnosis of prostate cancer that is important
Reduce the harms of treatment
Once diagnosed, the way we treat early prostate cancer can cause a lot of harm. Current treatments for early prostate cancer target the whole prostate, causing damage to surrounding structures. This can lead to urine leak, poor erections and back passage problems.
The research
I will test the ability of several markers in blood and urine as well as imaging to accurately predict the presence or absence of important prostate cancer.
I will also test whether treating the cancer only, in order to avoid damaging surrounding structures, is effective in cancer control and whether the harms of whole-gland treatments can be reduced.
The possible benefits
Reduce the number of men who undergo unnecessary prostate biopsy
Reduce the risk of being diagnosed with a harmless prostate cancer
Improve the diagnosis of prostate cancer that is important
Reduce the harms of treatment
Technical Summary
To improve the diagnosis and treatment pathways in prostate cancer so that fewer and better biopsies are taken with fewer and better treatments conducted.
Objectives
A. To evaluate the ability of novel tissue and imaging biomarkers to detect and rule-out clinically significant prostate cancer (fewer and better biopsies, fewer treatments)
B. To evaluate the genito-urinary, bowel, quality of life and cancer control outcomes after a issue-preserving strategy that targets only the area of prostate cancer (better treatments)
Design and Methodology
The two objectives will be evaluated in the following way:
A. Fewer and better biopsies, fewer treatments
1. Collect and store tissue samples and imaging data-files from men prior to biopsy
2. Validate known diagnostic tests in detecting and ruling-out clinically significant prostate cancer,
a) tissue biomarkers: urinary MSMB, serum kallikreins and PTEN-associated glycoproteins
b) imaging datafiles: diffusion-weighted and dynamic contrast enhanced MRI quantitative parameters and ultrasound tissue characterisation algorithms
3. Conduct a discrete choice experiment to evaluate men‘s preferences for, and trade-offs between, the attributes of different diagnostic strategies and tests
B. Better treatment
1. Conduct a phase II multicentre trial to evaluate the,
a) precision and reproducibility of genitourinary, rectal and health-related quality of life outcomes
b) medium-term histological outcomes of treated and untreated prostate tissue
c) clinical validity of tissue and imaging biomarkers in detection of local failure after focal therapy
2. Develop a predictive model, using tissue and imaging biomarkers to predict outcomes after focal therapy
3. Conduct a formal consensus panel meeting of international experts to discuss and develop a pragmatic randomised controlled trial protocol comparing focal therapy to standard of care
Scientific and Medical Opportunities
A. Fewer and better biopsies, fewer treatments
1. A risk calculator that may identify men who require a biopsy so that detection of clinically significant disease is improved and men with insignificant disease can avoid an unnecessary biopsy and treatment
2. A unique collection of blood and urine samples and imaging datafiles, linked to template mapping biopsy findings, that can be used to test future promising biomarkers of prostate cancer
Better treatment
1. The development of a pragmatic phase III randomised controlled trial protocol to evaluate the long term outcomes of focal therapy compared to standard of care
2. A unique collection of pre- and post-treatment pathological samples from men in whom the dominant or index lesion has been ablated and all other cancer foci remain in-situ.
Objectives
A. To evaluate the ability of novel tissue and imaging biomarkers to detect and rule-out clinically significant prostate cancer (fewer and better biopsies, fewer treatments)
B. To evaluate the genito-urinary, bowel, quality of life and cancer control outcomes after a issue-preserving strategy that targets only the area of prostate cancer (better treatments)
Design and Methodology
The two objectives will be evaluated in the following way:
A. Fewer and better biopsies, fewer treatments
1. Collect and store tissue samples and imaging data-files from men prior to biopsy
2. Validate known diagnostic tests in detecting and ruling-out clinically significant prostate cancer,
a) tissue biomarkers: urinary MSMB, serum kallikreins and PTEN-associated glycoproteins
b) imaging datafiles: diffusion-weighted and dynamic contrast enhanced MRI quantitative parameters and ultrasound tissue characterisation algorithms
3. Conduct a discrete choice experiment to evaluate men‘s preferences for, and trade-offs between, the attributes of different diagnostic strategies and tests
B. Better treatment
1. Conduct a phase II multicentre trial to evaluate the,
a) precision and reproducibility of genitourinary, rectal and health-related quality of life outcomes
b) medium-term histological outcomes of treated and untreated prostate tissue
c) clinical validity of tissue and imaging biomarkers in detection of local failure after focal therapy
2. Develop a predictive model, using tissue and imaging biomarkers to predict outcomes after focal therapy
3. Conduct a formal consensus panel meeting of international experts to discuss and develop a pragmatic randomised controlled trial protocol comparing focal therapy to standard of care
Scientific and Medical Opportunities
A. Fewer and better biopsies, fewer treatments
1. A risk calculator that may identify men who require a biopsy so that detection of clinically significant disease is improved and men with insignificant disease can avoid an unnecessary biopsy and treatment
2. A unique collection of blood and urine samples and imaging datafiles, linked to template mapping biopsy findings, that can be used to test future promising biomarkers of prostate cancer
Better treatment
1. The development of a pragmatic phase III randomised controlled trial protocol to evaluate the long term outcomes of focal therapy compared to standard of care
2. A unique collection of pre- and post-treatment pathological samples from men in whom the dominant or index lesion has been ablated and all other cancer foci remain in-situ.