Posts Tagged ‘prostate cancer clinical trials’

Recurrent Prostate Cancer: Where is it?

Tiffany Dunphy and Van Jackson, radiation therapists at Winship at Emory Saint Joseph's Hospital, work with prostate cancer patients undergoing radiation treatment.

Tiffany Dunphy and Van Jackson, radiation therapists at Winship at Emory Saint Joseph’s Hospital, work with prostate cancer patients undergoing radiation treatment.

“It’s a lot easier to plan the attack, if we know where the enemy is,” says Winship urologist Peter Nieh, MD. “If a cancer is still localized, we may want to try salvage therapy, either radiation or surgery, before advancing to something systemic.”

Depending on how primary treatment took place, a prostate cancer often comes back in the prostate bed (where the prostate gland was), and may appear in nearby lymph nodes. In advanced cases, the cancer may spread to the bones.

Emory radiologist and Winship member David Schuster, MD and radiochemist and Winship member Mark Goodman, PhD have been developing a PET (positron emission tomography) imaging probe that shows considerable potential for detecting recurrent prostate cancer.

Usually in PET imaging, radioactive glucose is injected into the body, and since cancer cells have a sweet tooth, they take up a lot of the radioactive tracer. But the tracer also appears in the urine, complicating prostate cancer detection efforts since the prostate is so close to the bladder. In contrast, the probe 18F-FACBC, based on amino acids, is taken up by prostate cancer cells but doesn’t appear as much in urine.

FACBC has its limitations. It also may be taken up in benign prostate hyperplasia or inflammation. This means it probably won’t be as useful by itself for evaluating primary prostate cancers, but it has a lengthening track record in recurrent cancer.

In a 2011 publication, Schuster and his colleagues compared FACBC to ProstaScint, a commercially available probe. FACBC showed superior sensitivity and specificity in detecting tumors outside the prostate bed. Schuster is now collaborating with Winship radiation oncologist Ashesh Jani, MD to study FACBC’s benefits in designing radiation treatments for patients with recurrent prostate cancer after prostatectomy.

In Jani’s clinical trial study for recurrent prostate cancer, which lasts until 2017, one group of patients is examined using FACBC, while another gets conventional imaging. The question is whether using information gleaned from FACBC to direct the radiation results in a longer lasting remission than with the control group.

Marble countertop salesman Paul Reckamp, who was a participant in Jani’s study, keeps a file on his phone noting his PSA levels for the last several years. Reckamp had a radical prostatectomy in July 2010 at Emory Saint Joseph’s Hospital, but the cancer appeared to come back a year and a half later. FACBC imaging confirmed that the cancer had appeared in nearby lymph nodes but not elsewhere, and doctors could then plan radiation treatment that drove his PSA levels back down again.

“I couldn’t have been more pleased with the study,” he says. “It told me and the doctors what we wanted to know.”

As a National Cancer Institute (NCI) designated cancer center, Winship Cancer Institute of Emory University’s participation in clinical trials ensures our prostate patients have access to progressive resources and technology. For men with recurrent prostate cancer, there are newer methods of imaging such as magnetic resonance imaging (MRI) and positron emission tomography (PET). 

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Cancer Clinical Study Leads to Video Tool for Prostate Cancer Patients

At Emory, research plays a key role in the mission to serve our patients and their families. Medical advances and improvements to patient care have been made possible by research and volunteer participation in clinical trials. More than 1,000 clinical trials are offered at Emory, making a difference in people’s lives, today.

Recently, a clinical study initiated by Winship Cancer Institute of Emory University, found that providing prostate cancer patients with a video-based education tool significantly improved their understanding of key terms necessary to making decisions about their treatment.

The breakthrough study was led by three Winship at Emory investigators; Viraj Master, MD, PhD, FACS; Ashesh Jani, MD; and Michael Goodman, MD, MPH; and is the feature cover story of this month’s Cancer, the peer-reviewed journal of the American Cancer Society.

In 2013, Master, Jani and Goodman released an Emory study that showed that prostate cancer patients (treated at Grady Hospital in Atlanta) experienced a severe lack of understanding of prostate key terms. The original study showed only 15 percent of the patients understood the meaning of “incontinence”; less than a third understood “urinary function” and “bowel habits”; and fewer than 50 percent understood the word “impotence.”

In response to their findings, the three principle investigators jumped to find a solution to the problem. The latest study explored using a video-based tool to educate prostate cancer patients on key terminology. The physicians predicted that with a better understanding of terms linked to disease, patients would be able to participate in shared and informed decision-making throughout the prostate cancer treatment process.

About the Prostate Cancer Video Trial:

  • 56 male patients were recruited from two low-income safety net clinics and received a key term comprehension test before and after viewing the educational video.
  • The video software (viewed by participants on iPads) featured narrated animations depicting 26 terms that doctors and medical staff frequently use in talking with prostate cancer patients.
  • Learn more by watching this video:

clinical trials for prostate cancer

Results of the Prostate Cancer Video Trial:

Participants who viewed the educational video demonstrated statistically significant improvements in comprehension of prostate terminology. For instance, before viewing the application, 14 percent of the men understood “incontinence”; afterward, 50 percent of them demonstrated understanding of the term.

“This shows that video tools can help patients understand these critical prostate health terms in a meaningful way. The ultimate goal is to give patients a vocabulary toolkit to further enable them to make shared and informed decisions about their treatment options,” says Viraj Master. “Our next goal is to improve the tool further, and study this tool at different centers.”

Learn more about clinical trials at Emory >>

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Additional Information about the Prostate Cancer Trial:

The research for this study was made possible by a Winship Cancer Institute multi-investigator pilot grant and the contributions of faculty and students from Winship, the Rollins School of Public Health and the Emory School of Medicine.

This study was led by three Winship at Emory investigators: Viraj Master, MD, PhD, FACS, Winship urologist and director of clinical research in the Department of Urology at Emory University; Ashesh Jani, MD, professor of radiation oncology in the Emory School of Medicine; and Michael Goodman, MD, MPH, associate professor of epidemiology with the Rollins School of Public Health.

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