HealthManagement, Volume 16 - Issue 2, 2016

Prostate Cancer Diagnosis and Management

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Clinical Trial to Test If MRI Can Replace Current Standard of Care

A team of scientists in Canada has secured funding for a ‏three-year Phase III clinical trial focused on improving ‏the way we biopsy for prostate cancer and whether ‏magnetic resonance imaging (MRI) can replace the current ‏standard of care to diagnose prostate cancer.


The PrECISE project to construct computational models to ‏improve prostate cancer treatment, has secured $3 million in ‏funding from the Movember Foundation, the Ontario Institute ‏for Cancer Research (OICR) and Prostate Cancer Canada to ‏determine whether MRI imaging can spare some men from ‏undergoing a biopsy and avoid the possible associated side ‏effects.


Leading the project is Dr. Laurence Klotz of the Sunnybrook ‏Research Institute in Toronto, the man who is credited with ‏coining the term ‘active surveillance’, a standard practice to ‏monitor patients with low risk prostate cancer. Dr. Klotz, a ‏world leader in the field of prostate cancer research, is also ‏a professor at the University of Toronto and the Chair of the ‏World Urologic Oncology Federation.


MRI technology is a precise tool that could better identify ‏which patients should undergo biopsy, and enable targeted ‏biopsy of only areas suspected of malignancy.


TRUS-Guided Biopsy Not Sensitive Enough


Currently, prostate cancer is diagnosed by trans-rectal ultrasound ‏(TRUS)-guided biopsy of the prostate, in most cases ‏following a Prostate Specific Antigen (PSA) test.


This form of biopsy carries potential side effects such as ‏infection and bleeding because it is not targeted, and requires ‏as many as 10 or 12 biopsy samples to establish an accurate ‏reading. In addition, this current standard of care is not ‏sensitive enough to discriminate between high-risk and very ‏low-risk changes in prostate tissue, resulting in the overdiagnosis ‏and over-treatment of many men.


Klotz believes that this trial would support a change in ‏practice from relying on biopsies for all men with suspected ‏prostate cancer to providing MRI first with selective targeted ‏biopsy. He said that this approach would allow 250,000 men ‏a year in the U.S. and Canada to avoid unnecessary biopsies ‏and the associated complications including hospitalisation.


OICR’s strategic priority is to improve the management of  ‏patients with early prostate cancer and to avoid over-diagnosis ‏while ensuring men with prostate cancer get the treatment ‏they need. Dr. Lincoln Stein, Interim Scientific Director of ‏the Ontario-based research institute said that using MRI to ‏image the prostate before biopsy will help reduce the number ‏of unnecessary biopsies and their associated complications, ‏while ensuring maximum precision for guiding the biopsy ‏when and where it is really needed.


Data management and analysis for the trial will be conducted ‏by the Ontario Clinical Oncology Group (OCOG) in the Escarpment ‏Cancer Research Institute, a Hamilton Health Sciences and ‏McMaster University institute.


“Approximately 20 years after PCC helped fund Dr. Klotz’ ‏watchful observation study, hundreds and hundreds of men ‏with low-risk prostate cancer have had an option to avoid ‏unnecessary treatment,” said Dr. Stuart Edmonds, PCC’s vicepresident ‏of Research and Health Promotion.

Further Information


The Movember Foundation is a global charity raising funds and awareness ‏for men’s health. Since 2003, $670 million has been raised to ‏fund over 800 programmes through impact investments, focusing ‏on prostate cancer, testicular cancer, poor mental health and physical ‏inactivity. The annual Movember campaign in November is globally ‏recognised for its fun and innovative approach to raise money and ‏get men to take action for their health.


Prostate Cancer Canada is the leading national foundation dedicated to ‏the prevention of the most common cancer in men through research, ‏advocacy, education, support and awareness.


Ontario Institute for Cancer Research (OICR) is an innovative cancer ‏research and development institute in Ontario, Canad, dedicated to ‏prevention, early detection, diagnosis and treatment of cancer. OI CR ‏has key research efforts underway in small molecules, biologics, stem ‏cells, imaging, genomics, informatics and bio-computing.

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