For over 40 years doctors have relied on traditional, two dimensional ultrasound technology as a fundamental tool to diagnose and treat prostate cancer. Now researchers at Robarts Research Institute in London, Ontario have developed a new 3-D imaging platform for prostate cancer that will allow physicians to find tumours more easily, make more accurate diagnoses and provide treatments that are more effective than ever before.
The imaging platform, developed by Dr. Aaron Fenster, Director of Imaging Research Laboratories at Robarts and Platform Leader of the Imaging and Intervention Platform at the Ontario Institute for Cancer Research (OICR), will allow physicians to see their patients’ tumours in near real time and in three dimensions. The research team plans to have three clinical prototypes in hospitals for initial trials by the end of this year.
“Finding prostate cancer is difficult,” Fenster says, noting that doctors are often looking for tumours that are only millimetres in size. “Many men have prostate cancer, but their physicians are unable to find it. If they cannot find it they cannot prove it is there, which means they can’t treat it.”
Currently, if physicians are relatively certain a patient has prostate cancer they rely on a test called a transrectal ultrasound (TRUS) to biopsy the prostate and diagnose the cancer. The TRUS test uses two dimensional ultrasound technology to find dark or dense areas on the prostate that could indicate cancer. This technology is limited because the two dimensional image only allows physicians to see one slice of the prostate at a time and because early stage prostate cancer is difficult to detect using current 2-D ultrasound imaging.
A biopsy is usually taken at the same time as the TRUS procedure. If physicians can’t actually see where the tumour is, they perform the biopsy on a region of the prostate they know has a high probability of harbouring the disease. This technique fails to detect tumours in as many as 34 per cent of TRUS guided biopsy procedures. A biopsy is considered a necessity for most doctors to make a definite diagnosis of cancer.
“The 3-D ultrasound imaging technique combined with MR imaging (MRI) promises to give doctors better imaging tools and allow them to see developing tumours sooner,” Fenster says. “That means there is more accurate information available for doctors and patients and important decisions about treatment can be made much earlier.”
“The sooner physicians find tumours and the more accurately they can diagnose them, the better care they can provide for patients,” says Dr. Tom Hudson, President and Scientific Director of OICR. “The 3-D context of Dr. Fenster’s work means that doctors no longer have to guess, they can see exactly where biopsy needles are going. This promises to have a positive impact on the diagnosis and treatment of Ontarians living with prostate cancer.”
Fenster’s lab is working on an entire ‘platform of technologies’ that includes everything from the equipment that actually acquires the biopsy to the device that creates the 3-D image. The technology runs on a standard PC and uses current standard procedures to minimize the necessity of retraining. “We’re trying to make this as inexpensive as possible for the health care system,” Fenster says. “We want hospitals to be able to adopt this technology quickly and begin treating patients as soon as possible.”
Computer tools developed by Fenster’s team also track exactly where tissue samples are taken on the prostate, making the technique reproducible if doctors need to follow-up on a previous treatment or check a treatment’s progression.
“There has been a tremendous response to this technology from the research community,” Fenster says. “We have licensed a few parts of this technology already and they have been developed by other companies into therapies that are being used worldwide.”
Fenster says that developing new diagnostic tools for prostate cancer is important because the disease can be treated effectively yet many people still suffer and die from it. Prostate cancer remains the most commonly diagnosed cancer in men and the third most common cause of cancer death in men, according to the Canadian Cancer Society. The Canadian Cancer Society estimates that 24,700 Canadian men will be diagnosed with prostate cancer and 4,300 will die of the disease in 2008.
The sooner a tumour can be detected, the more options there are for treatment and the better the chances of patients’ survival. “It is important that doctors can diagnose the cancer early when it can still be treated. This technology may be able to reduce the amount of biopsies necessary and reduce the morbidity of the patients,” Fenster says.
Fenster is now using new funding provided by OICR’s Commercialization group to develop and validate his technology in the clinic. He is hoping to create an Ontario-based company that will have the capacity to manufacture the platform in Ontario for cancer patients worldwide.
Once testing is complete, this technology could significantly alter diagnosis and treatment of cancer in the clinic. “Maybe this won’t make a prostate exam easier,” Fenster says, “but it will hopefully make it better.”
Fenster’s lab is also using the imaging technology to provide similar 3-D imaging solutions for breast and liver cancer.