Translational Prostate Cancer Research Team
Dedicated to Conquering Prostate Cancer
The Translational Prostate Cancer Research Team is comprised of a network of clinicians and researchers citywide within London exploring advanced diagnostics and treatments across the spectrum of prostate cancer from early diagnosis to treatment of metastatic disease. The Team includes: Dr. Glenn Bauman, Dr. Joseph Chin, Dr. David D'Souza, Dr. Ricardo Fernandes, Dr. Douglas Hoover, Dr. Len Luyt, Dr. Timothy Scholl, Dr. Jonathan Thiessen, Dr. Aaron Ward, Dr. Eric Winquist and Dr. Eugene Wong.
Specific areas of interest include
Developing Novel Molecular Probes and Prostate Cancer Therapeutics
A group of dedicated chemists working in the Gerald C. Baines Centre for Translational Cancer Research are developing new imaging agents that are specific for prostate cancer and will allow for improved treatment decisions to be made. Non-invasive imaging can be carried out using these novel PET agents to provide biochemical information about a tumour, assisting in treatment decisions. A theranostic approach follows the motto, 'if you can image it, you can treat it', and these imaging agents have the potential to be a prostate cancer diagnostic - therapeutic pair.
Advanced Prostate Cancer Imaging for Prostate Cancer Diagnosis and Treatment Planning
Through collaborations between Oncologists, Uro-Oncologists, Pathologists and Imaging Scientists, we are exploring the use of advanced prostate cancer imaging to aid in the detection and treatment planning of early stage prostate cancer as well as the detection and characterization of recurrent disease. For example, we have led in the use of multi-parametric MRI and histopathology correlations to develop imaging based models to predict the location of intra-prostatic foci of cancer to guide biopsy, focal therapies and planning for surgery or radiaotherapy. This work includes developing novel MRI imaging such as Sodium MRI to provide biologic characterization through non-invasive means. We are also leaders in the use of PSMA Pet imaging and have led work in understanding the correlation of PSMA PET uptake within the prostate and the histologic distribution of cancer. Through research studies like the Ontario PREP registry study, ARGOS/CLIMBER and ROADSTER, we are seeking to better understand how PSMA targeting PET imaging can be used to guide management for the primary treatment of prostate cancer and the early detection and management of early recurrence.
Functional and molecular imaging are key to the diagnosis and therapy guidance of prostate cancer. For these purposes, we have developed imaging techniques using CT Perfusion, MRI and PET to identify the dominant intraprostatic lesion (DIL) that is associated with tumor recurrence and treatment relapse. We have shown that MRI radiomics and PET with the targeted probe [18F] DCFPyL, a ligand for prostate specific membrane antigen (PSMA) expressed by prostate cancer cells identify the DIL with high accuracy thereby can contribute to better tumor control by pinpointing the lesion where radiation does should be escalated. More recent effort is directed towards using PET imaging to determine the bio-distribution of targeted radionuclides (eg. [177Lu]PSMA) to allow accurate calculation of radiation dose to the prostate and critical organs. This will allow individual patient's treatment plan to be optimized for treatment efficacy while minimizing complications.
Minimally Invasive Prostate Cancer Interventions
"Minimally Invasive" approaches to prostate cancer therapy in suitable cases have become increasingly popular. For the past several decades, our centre has been on the forefront, nationally and internationally, in researching and providing minimally invasive ablative therapies, starting with cryosurgery (CRYO) in the 1990's, then transitioned to High Intensity Focused Ultrasound (HIFU). We have prospectively amassed a large experience of CRYO and HIFU whole-gland treatments for patients who had suffered recurrence following radiotherapy for their prostate cancer ("salvage therapies"), and we have maintained a database with one of the world's longest follow-ups. We have performed detailed combined and comparative analyses with databases from other cancer centres: MD Anderson Cancer Center, Memorial Sloan Kettering Cancer Centre, Mayo Clinic, the results of which have led to modifications in approaches in salvage therapy for prostate cancer.
In collaboration with our researchers in Advanced Imaging, novel MRI techniques and PSMA PET imaging (vide supra) are being incorporated into pre-operative patient evaluation, and an increasing percentage of eligible patients are offered "focal ablative salvage therapy" where ablative treatment (eg. HIFU) is precisely directed at the affected lesion or region of the prostate, instead of treating the entire gland. Advanced imaging techniques have enabled more accurate delineation of cancerous lesions or regions from neighbouring non-cancerous tissues. Focal ablative therapy is designed to further decrease treatment-related morbidity by minimizing "collateral damage" to adjacent non-cancerous tissue, whilst maintaining treatment efficacy.
Since 2013, we have been evaluating another novel minimally invasive ablative technology, transurethral ultrasound ablation (TULSA) as an alternative therapy for localized prostate cancer. We led a tri-national (Canada, Germany, USA) Phase I study on primarily low-risk patients with TULSA, whereby eligible patients were treated in-bore (in MRI unit) with a transurethral probe emitting ablative ultrasound heat energy "outwards" from the uretha radially to the prostate gland tissue. Ablative treatment was rendered by firstly, MRI-assisted gland contouring and treatment-planning, then real-time intraoperative MR thermometry (monitoring by "heat maps") and finally, post-treatment Gadolinium-enhanced imaging to assess completeness of ablation. We have completed a large Phase II trial involving 11 centres worldwide for primary whole-gland and are now in the planning stages for further evaluation of this ablative system, comparing TULSA with established standard therapies such as radiotherapy and radical prostatectomy.
New Therapeutics for Metastatic Prostate Cancer
Clinical Trials are a pillar of prostate cancer research in London, providing both the opportunity to test innovative treatments and also earlier access to new therapies for patients. Clinical researchers at the CTCR have been involved in prostate cancer clinical trials testing new radiation approaches, chemotherapy drugs, hormonal and targeted agents, and radio-isotope therapies that have been practice changing for many years, and this continues. Current trials are testing aggressive drug therapy prior to surgery for higher risk localized prostate cancer, and use of focused and aggressive radiation treatment in men with limited sites of cancer spread. For patients with advanced disease, precision medicine trials are testing targeted drug therapies based on the results of genetic testing of DNA in a patient's blood, the addition of radium-223 to androgen receptor targeted therapy, and novel radio-isotopes directed at the PSMA protein over expressed on prostate cancer cells.
Please consider donating to the Translational Prostate Cancer Research Team by way of the London Health Sciences Foundation office or join the London Ontario, Dash 4 Dad Walk/Run event
For more information on current research projects: check out this virtual prostate research video featuring Dr. Glenn Bauman, Dr. Joseph Chin, Dr. Ricardo Fernandes, Douglas Hoover, PhD., Dr. Lucas Mendez and Aaron Ward, PhD.
