Low-risk Prostate Cancer Treatment Options

Multidisciplinary Team Delivers Comprehensive Options and Evaluates New Treatments for Patients with Low-risk Prostate Cancer

An expert team of urologists, radiologists, radiation oncologists, and medical oncologists at Brigham and Women’s Hospital (BWH) and Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) are providing comprehensive care and studying innovative approaches to evaluate and manage low-risk prostate cancer.

“Unlike patients with advanced and aggressive cancers, low-risk prostate cancer may not need to be actively treated. The challenge is determining which patients with low-risk prostate cancer should be treated and what types of treatment are preferable in these cases,” said Adam S. Kibel, MD, Chief of the Division of Urology at BWH and Surgical Director of the Lank Center for Genitourinary Oncology at DF/BWCC. “This has shifted our focus to both enhancing our diagnostic techniques and investigating less invasive treatment options. Our goal is to cure only those who need to be cured with reduced morbidity.”

Extensive Prostate Biopsy Program Offers Customized Diagnostic Approach

The prostate biopsy program at BWH has been at the forefront of worldwide changes in prostate cancer diagnosis. The program’s unique partnership between urologists and subspecialized genitourinary radiologists has led to pioneering work in performing biopsies using a transperineal approach with in-bore MR image guidance. Targeted biopsies using MRI to detect the targets have demonstrated a high yield of more significant cancer than non-targeted biopsies. With the advent of MR + ultrasound fusion, the in-bore MR guided biopsies are generally used for tumors in difficult locations.

The prostate biopsy program is one of few in the country that is experienced in the dual approaches of in-bore MR guided biopsy and MR + ultrasound fusion. These two approaches complement each other, enabling specialists to access lesions located in many areas of the prostate. Regular multidisciplinary biopsy conferences are held with urologists, radiologists, and pathologists, to discuss cases and biopsy planning.

“With the availability of these advanced technologies, we can tailor the biopsy approach for each case and deliver individualized evaluation for each patient,” said Quoc-Dien Trinh, MD, urologic surgeon in the Division of Urology at BWH and Co-Director of the Prostate Cancer Program at DF/BWCC.

Managing Men with Low-risk Prostate Cancer

BWH urologists use a multi-pronged approach in developing a treatment plan for patients with low-risk prostate cancer:

  • Conventional surgical treatments (including robotic, laparoscopic and open prostatectomy) and radiation therapy (brachytherapy and external beam radiation) are considered for low risk patients who have a family history of aggressive prostate cancer, especially those who have lost a family member to the disease;
  • Based on the team’s published research on biomarkers that indicate a more aggressive tumor (Cancer Epidemiol Biomarkers Prev.2016 Nov;25(11):1456-1463), they are investigating the role of biomarkers in predicting who needs active treatment;
  • For patients with small volume, low-risk cancer, active surveillance is offered as an optimal option, especially for younger patients relative to quality of life.

“We provide a very specialized program for patients with low-risk prostate cancer,” said Dr. Kibel. “After expert evaluation, we carefully weigh the benefits and risks of treatments with the likelihood of disease progression within the patient’s expected lifespan. Our team collaborates to determine the best approach for each patient.”

Focal MR-guided Focused Ultrasound

Urologists and interventional radiologists at BWH are among few in the nation and the only specialists in New England to participate in a new early-phase device study of MR-guided focused ultrasound surgery in patients with small volume, low-to-moderate risk localized prostate cancer. This prospective, single arm study (Focal MR-Guided Focused Ultrasound Treatment of Localized Low and Intermediate Risk Prostate Cancer: Feasibility Study) is enrolling up to 100 patients in 10 centers across the United States. Participants will be followed up for 24 months. The primary endpoints of the study include evaluation of overall safety and tumor control, as well as the incidence and severity of adverse events.

“This trial builds on a long history of pioneering research and clinical translation in MR-guided focused ultrasound surgery at BWH over the past 20 years,” said Clare M.C. Tempany, MD, Site Principal Investigator of the trial, Director of the National Institutes of Health (NIH) National Center for Image Guided Therapy (NCIGT) at BWH, and Co-Director of the BWH Advanced Multimodality Image Guided Operating (AMIGO) Suite. “We are optimistic that the concept of treating the tumor, not the prostate, will allow us to cure patients who need to be cured, while maintaining quality of life. We expect that this will be the first of many trials that will redefine management of small volume prostate cancer.”

Contact Us

For more information regarding this trial, please contact Jason Lee at (617) 726-5866.

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