In current practice, early-stage prostate cancer is managed without knowing exactly where cancer is in the prostate gland. As part of diagnosis, biopsy needles take tissue samples from the same predetermined areas in the prostate, regardless of where the cancer is, whereas targeting cancer seen in medical images is the standard procedure in most other cancers. This means that some clinically important cancers that require treatment are missed completely, some clinically unimportant cancers, which would otherwise have no impact on the individual's life expectancy or quality of life, are detected, and many other cancers are classified incorrectly as unimportant. As a result, current treatments try to compensate by treating not only the cancer, but the entire prostate gland. However, this approach gives rise to side-effects, such as incontinence, sexual problems, and back-passage symptoms, due to "collateral damage" to delicate structures surrounding the prostate.
Research led by Professor Mark Emberton and Dr Dean Barratt at University College London (UCL) seeks to rectify this situation. Their HICF-funded project proposes to combine state-of-the-art diagnostic imaging with advanced image guidance technology so that doctors are provided with information on cancer location, shape, and size during surgical procedures. The aim is to transform prostate cancer care by enabling doctors to target clinically important cancers so that these are diagnosed more accurately. They can then choose to target treatment only to the area of cancer so that tissue damage is limited and the risk of treatment-related side-effects is reduced. This approach is already applied when treating almost all other cancer.
The project focuses on developing a novel device called “SmartTarget” which will ensure that information on the location of cancer from medical imaging is at the centre of the diagnosis and treatment of prostate cancer. In particular, the SmartTarget system will exploit magnetic resonance imaging (MRI), which can detect clinically important cancers very accurately, and translate information on cancer location, size and shape automatically into the surgical setting so that it can be used to direct and guide prostate biopsy and new minimally-invasive cancer treatments. The system will achieve this by presenting the doctor with a “picture” that combines information from MRI with information from ultrasound images that are widely used to guide the biopsy needle and treatment delivery. This will allow the doctor to identify and target the cancer on a computer screen in a similar way to a fighter pilot presented with a target on a head-up display.
Anticipated benefits of this technology include fewer biopsies and more accurate cancer diagnosis. We also expect that the ability to implement a more selective treatment strategy will result in less harm and cost significantly less than current strategies which treat the whole prostate gland.
The specific objectives of the project are to develop and test a prototype SmartTarget device on patients, to develop detailed plans to commercialise the device, and to introduce the technology within the NHS (and potentially other healthcare systems) within a 5 year period.