New Technology Observed at 2008 AUA Conference

By Jim O’Hara, PCRI Educational Facilitator
Edited from PCRI Insights August, 2008 v 11.3

PCRI was well represented at the 2008 Annual Conference of the American Urological Association (AUA) this past May in Orlando. Executive Director Mark Scholz, MD and Chief Operating Officer Joe Bueno met with exhibitors and attendees to promote PCRI and our September 2008 conference. Jan Manarite and I attended many of the sessions, while my wife Linda, a PCRI volunteer, greeted attendees at our exhibit highlighting PCRI services.

Jan Manarite & Jim O'Hara Exhibit at AUA

Attended by 10,000 specialists in Urology from around the world, the AUA Conference featured 20 lectures/panel discussions, 25 courses, and over 600 abstracts highlighting prostate and prostate cancer issues. (Some of the abstracts were reviewed by Dr. Scholz in the May 2008 issue of Insights.) The abstracts and posters are available on the AUA website and can be searched by number, author, title and subject. You only need to register at one of the following:

• http://www.abstracts2view.com/aua/
• http://www.posters2view.com/aua08/

I personally heard several interesting presentations and viewed many of the poster sessions. I will focus this report on some of the new technologies available for prostate cancer physicians and patients.

GPS for the Body®

Organs naturally move during radiation treatments, and physicians cannot predict which way or how much organs will move. According to the manufacturer, Calypso Medical Technologies, its Calypso® 4D Localization System™, (also referred to as “GPS for the Body®”), enables radiation oncologists to accurately align the prostate prior to initiating each radiation treatment and then to manage any organ motion that may occur during the treatment session.

Prior to initiating external beam radiation therapy, doctors implant three tiny Beacon® electromagnetic transponders into the prostate during an outpatient procedure similar to a biopsy. Each Beacon® transponder is about the size of a grain of rice. The Beacon® transponders communicate with the Calypso System using safe radiofrequency waves during radiation therapy. The prostate position is continuously monitored during each treatment on a Calypso System display located within the treatment room. This display allows physicians to make quick, important decisions about the patient’s treatment if, during treatment, the prostate goes out of alignment with the radiation beam.

The technology is designed for body-wide cancers commonly treated with radiation therapy, including prostate, breast, lung, head, neck and other radiation therapy target organs. The products are FDA 510(k) cleared for use in the prostate and prostatic bed. Many leading cancer centers such as Fox Chase, Seattle Cancer Care Alliance, MD Anderson Orlando, and others have adopted this technology. More information is available at: www.calypsomedical.com.

4D Image Guidance and Navigation for Prostate Biopsy

A new imaging device, ei•Nav/Artemis™, was officially cleared by the FDA in May 2008. According to the manufacturer, the Eigen Corporation, the device offers urologists technology that will significantly help in the fight against prostate cancer. Artemis provides 4D image guidance and navigation for prostate biopsy. With the advantages of enhanced imaging, the physician will have the visual acuity to see the prostate in any dimension and to examine the prostate gland for abnormalities or any suspicious regions that may need sampling.

Artemis converts 2D Ultrasound to 3D/4D, provides enhanced biopsy-planning features, including needle navigation, and records this information for future reference. Unique to Artemis is the Atlas/HotSpotTM planning feature that is a statistical probability of known locations based on age, ethnicity, and PSA scores. Additionally, Artemis provides pre-loaded biopsy plans using conventional plans or the physician’s customized biopsy plan. During a biopsy, Artemis displays (1) the 4D orientation and navigation of the needle trajectory, (2) core position, (3) depth, and (4) deflection. With reproducible accuracy, Artemis allows the physician to view previous prostate gland volumes and biopsy locations. All of this information is recorded and saved for future reference, treatment planning and monitoring. More information is available at: www.eigen.com.

John Kurhanewicz, PhD, of the University of California San Francisco, believes that by converting 2-D ultrasound images to 3-D, Artemis provides an ability to merge high-end imaging from Magnetic Resonance Imaging and Spectroscopy with ultrasound images. He feels that this combination should provide a significant enhancement to the ability to locate tumors and perform targeted biopsies. A prospective study is planned at UCSF.

Prostate Px⊕®

Graphic courtesy of Aureon Laboratories, Inc

Aureon Laboratories, Inc. (a specialized laboratory dedicated to advancing personalized cancer treatment through predictive pathology) announced the introduction of Prostate Px⊕, the first commercial test to predict prostate cancer progression and disease recurrence at the time of diagnosis. Prostate Px⊕ is designed to detect high-risk patients who present as being low-risk and undetectable by other methods. It will also reclassify intermediate-risk patients and help identify those with less aggressive disease. According to Aureon, Prostate Px⊕ is based on the results of a large study that utilized data and samples from a cohort of 1,027 men assembled from the Mayo Clinic, Uppsala University, the University of Connecticut, and the Duke University Medical Center. In validation, Aureon’s predictive model identified twice as many high-risk events in low and intermediate risk patients than the previously best available method.

Prostate Px⊕ utilizes patient biopsy tissue to provide a perspective that enables more-informed decisions at diagnosis, Aureon explains. The Prostate Px⊕ “Systems Pathology” platform combines histologic, molecular, and clinical information to predict cancer recurrence by integrating three advanced technologies: (1) digital image analysis using architectural information available at the tissue level; (2) biomarker detection using fluorescently tagged antibodies with analysis via spectral imaging; and (3) clinical information such as: Gleason score, pathologic stage, and PSA values. This advanced mathematical approach is applied to a large patient cohort to generate a personalized report that is sent to the physician for discussion with the patient. More information is available at: www.aureon.com

3D Imaging and Targeted Biopsy

According to Envisioneering Medical Technologies, its TargetScan 3D imaging and targeted biopsy system allows a physician to generate a true solid 3D image, manipulate it, and precisely plan and undertake a multi-sample biopsy of a targeted tissue mass in the prostate. The probe remains stationary during the procedure while imaging a full range of scan planes to create a 3D image in seconds. Since the position of the prostate is not disturbed by moving the probe, this both provides for more accurate sampling of the prostate’s different zones and also provides better patient comfort.

A study by Andriole et al¹ reported that “targeted transrectal biopsy specimens of the prostate were taken. The precise location of each specimen is defined by 2 coordinates: depth in centimeters proximal from the apex of the prostate, and degree of rotation (clockwise or counterclockwise from 12 o'clock)… Studies on 20 radical prostatectomy specimens disclosed that simulated TargetScan biopsy correctly identified cancer in 16 (80%) prostates and high-grade prostatic intraepithelial neoplasia (PIN) in 2 others. Simulated TargetScan biopsy correctly characterized 88% of prostatic octants in terms of whether or not they harbored cancer. This technique was reproducible from operator to operator, and 85% biopsy core concordance was attained” … The TargetScan biopsy system seems to be an effective transrectal alternative to transperineal, 3-dimensional, ultrasound-guided biopsies. Its reproducibility from operator to operator suggests that it may be useful for guiding re-biopsy of specific locations within the prostate and for providing targeted focal prostate cancer therapy.” More information is available at: www.envisioneeringmedical.com.

^{1 Andriole GL, et al: Is there a better way to biopsy the prostate? Prospects for a novel transrectal systematic biopsy approach. Urology. 2007 Dec;70(6 Suppl):22-6.}

Circulating Tumor Cells

In an AUA course on High-Risk Prostate Cancer, J. Brantley Thrasher, MD discussed Abiraterone results and mentioned “circulating tumor cells”, a new marker for monitoring prostate cancer. In February 2008, Veridex, LLC announced that the FDA had granted an expanded clearance for the CellSearch™ System to be used as an aid in the monitoring of metastatic prostate cancer patients. According to Veridex, the CellSearch™ System identifies and counts circulating tumor cells (CTCs) in a blood sample to predict progression-free survival and overall survival in patients with metastatic breast, colorectal or prostate cancer, and can do so earlier than the current standard of care.

In the Veridex announcement, Dr. Nicholas Vogelzang of the Nevada Cancer Institute was quoted as follows: "We have compared CellSearch™ CTC test results to the standard clinical and biomedical parameters, such as prostate specific antigen (PSA) measured in metastatic prostate cancer patients. A decrease in the number of CTCs is most often associated with patients successfully responding to therapy. Further analysis of CTCs may provide information as to the most efficacious treatments for specific individuals."

More information is available at: www.veridex.com

 

Prostate Cancer Research Institute (PCRI)
 

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