Prostate Gland is a tiny gland, only about the size of a walnut, but it can be an outsized source of misery. The prostate gland is the most common target of cancer in men.Nearly 220,000 will be diagnosed with prostate cancer in the U.S. this year and 32,000 died from it in 2010. Tens of thousands of others suffer from serious after-effects of standard treatments, including total prostate removal and radiation.
The choices are especially problematic for men who catch their cancer early. Removing the prostate gland (prostatectomy) to fight early-stage cancer is an approach that can be compared with “using a sledgehammer to deal with a gnat,” says E. David Crawford, MD, head of the section of Urologic Oncology at the University of Colorado School of Medicine.
Prostatectomy, moreover, improves survival chances for only a tiny fraction of men. Survivors frequently suffer from erectile dysfunction, incontinence and other problems.
But with the help of a five-year, $2 million endowment, Crawford believes he and his colleagues at the University of Colorado Cancer Center could soon be at the forefront of a rapidly evolving new mode of disease attack, one that could dramatically improve patients’ quality of life.
The endowment, from millionaire Utah businessman and entrepreneur Marc Bingham, will be used to fund marketing, patient recruitment and research initiatives for a new program based in the hospital’s Urologic Oncology Clinic, Crawford says.
The treatment strategy: combine three-dimensional imaging that pinpoints the precise location of early-stage tumors and minimally invasive “targeted focal treatment” (TFT) techniques that eradicate cancerous tissue while preserving the healthy parts of the gland.
It’s a development Crawford likens to advances made in breast cancer treatment, where legions of women who years ago would have undergone radical mastectomies to treat cancer now get lumpectomies to remove small tumors. “In subsets of women whose cancers are not extensive, physicians perform lumpectomies with additional treatments,” he says. “[In urology], we’ve been in the dark ages, where we’ve treated the whole prostate gland. But now there is a revolution underway in the treatment of small cancers.”
Crawford estimates that 40 percent of men with prostate cancer could benefit from TFTs, bolstered with three-dimensional mapping biopsies he developed with Urologic Oncology Director of Research Al Barqawi, MD, FRCS. The technique involves taking as many as 90 tissue samples along a grid spaced at regular intervals, then integrating the pathology results with two-dimensional ultrasound images to create three-dimensional pictures of the prostate gland. Providers use these pictures to put the tumor in the cross-hairs.
The hospital already uses the 3-D mapping technology in combination with cryoablation (freezing) that kills tumors while preserving healthy prostate gland tissue.
In 2009, Barqawi performed for the first time targeted prostate surgery that used 3-D mapping to find a small tumor and a laser that cooked only the cancer. He’s since performed a handful of the procedures following a research protocol for a clinical trial.
Urologic Oncology leaders believe the endowment will help seed research for new tumor-killing TFTs, including direct electrical currents; gene sequencing that sensitizes only the cancer cells to radiation; high-intensity focused ultrasound; and radioactive “seeds” implanted directly in the tumor.
“The key to moving these therapies forward is we have to build the volume of patients,” says Cliff Jones, PhD, senior professional research assistant with Urologic Oncology. The endowment, he believes, could give the program the time to increase the flow of patients and document improvements in quality of life he is certain TFTs will afford men. Whatever the technique, the overall goal is to offer men with early-stage prostate gland cancer an alternative to the three prevailing choices: prostatectomy, radiation (either by external beam or radioactive seeds injected into the gland) or “active surveillance” of their condition with regularly scheduled biopsies.
They’ve been the alternatives primarily because it isn’t easy to find prostate tumors. Computer tomography and magnetic resonance imaging can’t distinguish between healthy and cancerous tissue. Physicians typically rely on a series of needle biopsies to find cancerous areas of the prostate gland, but the approach often doesn’t reveal the exact location of the tumor, and it can miss areas of disease if the cancer has spread.
If you can see it, you can kill it, Crawford notes. “Finding the cancer is the hard part,” he says. “Getting rid of it is easy.” A study Crawford led of 25 men who underwent 3-D mapping biopsies before radical prostatectomies between 2007 and 2010 at UCH demonstrated the accuracy of the technique, both in detecting cancerous lesions and assessing their severity. Researchers correlated the mapping biopsies with the results of pathology reports from microscopic examination of tissue slices of the whole prostate gland.
“We were able to detect all significant lesions,” says Urology Post- Doctoral Research Fellow Kyle Rove, MD. The mapping technique predicted the tumors’ Gleason scores – a measure of severity – with 72 percent accuracy. Researchers upgraded just 8 percent of the tumors when they examined them after the prostatectomies.
An accurate picture of the prostate gland improves clinicians’ chances of tailoring treatment to the individual patient, Rove says. “We have an opportunity to personalize care based on how big the tumor is and where it is. We can take the whole patient into account.”
Resources from the endowment will afford the opportunity to test the new approaches rigorously, Rove adds. “This is a young arena. There are still questions in terms of outcomes, quality of life and cost.”