Scientists: Aaron Fenster, PhD, FCCPM, Giles Santyr, PhD, Grace Parraga, PhD, Paula Foster, PhD, Ravi S. Menon, PhD, Rob Bartha, PhD, Terry Peters, PhD, FCCPM & Ting-Yim Lee, PhD, FCCPM
Treatment & Clinical Trials
Imaging is used to improve and guide prostate biopsy, allowing early diagnosis at a stage when the cancer is curable and the disease can be staged accurately, and to develop new technology to improve minimally invasive prostate therapy. In addition, the team is creating new ways to look at cancer treatment responses with a special focus on lung cancer, the largest cancer killer of men and women in Canada.
3D Ultrasound-Guided Prostate Biopsy
Definitive diagnosis of localized, early stage prostate cancer has a significant false-negative rate (15 to 25%), which means that men who actually harbour curable prostate cancer are not detected on the first biopsy. The physician then is faced with a difficult challenge, requiring imaging with other modalities and a second and sometimes a third biopsy. Researchers in the cancer imaging research team have invented a 3D ultrasound-based system to improve planning and recording of the exact 3D biopsy coordinates in the prostate, which will help to resolve these issues, especially when suspicious tissue results require sampling from the same location as the initial biopsy. In addition, this new technique can make use of images from other imaging modality (e.g., MRI) to guide the biopsy needle to the target.
3D Ultrasound-Guided Prostate Therapy
Managing the increasing number of men with early stage cancers has generated a great deal of debate with a growing belief that aggressive therapy may not be justified for early stage disease, and that minimally invasive therapy, such as cryosurgery, brachytherapy, thermal therapy, or photodynamic therapy is a viable option. These strategies promise to reduce patient morbidity, recovery time, hospital stay, and overall cost, while preserving or increasing clinical efficacy. Imaging technology for real-time treatment guidance and monitoring is critical to the accurate delivery of these therapies and to their safety and effectiveness. Our researchers have pioneered a 3D prostate US imaging for minimally invasive prostate cancer therapy that uses robotic aids and innovative real-time image guidance and verification tools, allowing all aspects of the procedure to be carried out intra-operatively for use in saturation biopsy, low dose-rate brachytherapy, high dose-rate brachytherapy, cryotherapy, thermal therapy, and photodynamic therapy.
3D Multi-modality Imaging and Pathology for Prostate Cancer Diagnosis and Treatment
The CIHR Team in Image Guidance for Prostate cancer seeks to generate co-registered three dimensional, multi-modality pre-operative prostate cancer images (MRI,CT,U/S, PET) with post-operative three dimensional digitized pathology images to develop predictive models of prostate cancer growth and aggressiveness to aid in the planning and delivery of minimally invasive therapy. The development of accurate three dimensional predictive models of prostate cancer based on non-invasive, clinically available imaging techniques will be integrated with other technology platforms being developed at Robarts and among the CIHR Team partners (3D ultrasound guided biopsy, minimally invasive therapies like cryotherapy and laparoscopic surgery, image guided radiotherapy) to improve outcomes for men with prostate cancer. The capabilities being developed through the CIHR Team (accurate co-registration and statistical analysis of three dimensional imaging and digital pathology) provides capabilities that can be leveraged for other cancers and diseases.
Ultrasound and MRI-Assisted Laparoscopic Cancer Surgery
In many cases where cancer tumours are either resected from one organ (e.g. kidney), or removed by radical excision of the organ itself (prostate), it is important to know the location of the tumour relative to the incision. In the former case, this allows maximal sparing of the decisions regarding the extent of the required margin in relation to the neurovascular bundles. Our researchers are addressing this problem by integrating ultrasound and pre-operative MR information into the space visualized by the laparoscope, allowing the surgeon to “see through” the organ surface to visualize the tumour.
Better Imaging of Lung Cancer for Better Lung Cancer Treatment and Survival
The prognosis for patients with lung cancer who are not candidates for surgery is dire, with improvements in response and survival not changed significantly over the last 30 years. In other words, the promise of highly precise, computerized, and improved therapy, imaging, and radiation methods has not been realized for patients with lung cancer. To directly address this issue, the team is developing new ways to measure lung tumour treatment response from diagnostic images. These methods are rapid, automated, and independent of specialists, and have the goal to include these measurements in clinical trials of new treatments. Another goal is to provide a rapid measure of the tumour before therapy to help target personalized treatment, and to evaluate changes in tumours in response to treatment. Many outstanding questions remain related to the best methods used to measure tumour response to therapy. What happens to tumours when they respond to therapy? What differentiates those tumours that respond over longer periods of time and those that do not? These questions are particularly pressing in the measurement of lung cancer because the efficacy of conventional therapies is mediocre. Improved methods to measure lung tumour response to new molecular-targeted agents are clearly required, and the development of such techniques will facilitate similar measurements for liver, brain, and other cancers.