Novel technique may help some patients with prostate cancer avoid common adverse events

MRI–guided focal therapy, a novel tumor-destroying technology, is being investigated at Brigham and Women’s Hospital to spare patients with prostate cancer from some of the most common adverse events that often accompany standard treatment.

“We have patients who need to be treated, and the current treatment modalities have side effects,” Adam Kibel, MD, chief in the division of urology at Brigham and Women’s Hospital, said in a press release. “If this could cure patients and, at the same time, maintain quality of life, it would be a huge step forward in our treatment of prostate cancer.”

Adam Kibel

Kibel spoke with HemOnc Today about MRI–guided focal therapy for prostate cancer and whether this treatment modality could be a major breakthrough in prostate cancer care.

Question: How does focal therapy work?

A: The idea of this therapy is to only destroy the cancer, not the entire prostate. First, the cancer has to be identified with MRI, and you have to ensure that the cancer is only located in one place. We take a lot of steps to ensure that the cancer is only located in the one place, because one of our concerns is that the cancer is going to be located outside of the treatment field, and not all lesions are visible on MRI. Once you are certain that that is the only place the cancer is, you focus the MRI scanner on the lesion. There are a couple of things that are good about this. First, you can actually see the lesion, whereas — when you do something under ultrasound as opposed to MRI — you do not know if you are destroying healthy tissue in addition to the lesion. Second, MRI can detect changes in heat, so you can follow the changes in tissue in real time.

Q: How was the treatment developed?

A: There are many experts, both in industry and medical centers, looking at focal therapy as a treatment modality. This product was developed by an Israeli company that was interested in treating prostate cancer while avoiding some of the most common adverse events associated with prostate cancer treatment, including impotence and incontinence. Focal therapy treatment focuses the ultrasound in a very precise way and includes a probe that you can put in an MRI scanner. One of my concerns about focal therapy in the past was that I was never certain that the treatment was hitting an important cancer. MRI has solved this. The MRI provides the target. I also was skeptical of the treatment because studies were of low-risk prostate cancer, not intermediate- or high-risk cancer. For low-risk cancer, patients are very unlikely to die of the cancer and they hardly need any treatment. If worried about side effects, the patient does not undergo treatment.

Q: What has preliminary research shown so far about efficacy and safety?

A: Not a lot, so far. We have only treated one patient with the technique at Brigham and Women’s Hospital. But, it sparked a lot of attention from people who see this as a wonderful idea. At this time, I have no data to discuss because we have only treated one patient and we have not yet analyzed the data. We did see that the lesion was ablated, but there is a protocol that we need to follow. Our first patient has really taken a leap of faith. I am very thankful to him for going through with this and putting his faith in us.

Q: How optimistic are you that this could potentially be a major breakthrough?

A: I am cautiously optimistic. I actually think focal therapy will become something that is routinely used in patients in the future. However, there are an awful lot of pieces to this puzzle and they are still being developed. The imaging aspect for instance is very important — as this improves, so will our treatment.

Q : How long until we know whether this is a viable alternative to standard treatment?

A: My guess is a couple of years. One of the real questions needing to be answered is whether this is a treatment that is effective. It depends on what the endpoint is going to be. If the endpoint is survival, then it will take a long time to prove this. It is one of the problems with a treatment like this.

Q: Is there anything else that you would like to mention ?

A: There are a lot of people who are investigating these types of treatment modalities, not only at our institution but at others. It is my belief that this is going to be a part of the armamentarium for the treatment of prostate cancer. But right now, outside of a clinical trial, I do not think that it really has a good role because no one has proven that these treatments have an impact on disease. Most patients treated outside of clinical trials are people who may not need to be treated in the first place. There are plenty of people with cancer who are going to die with the disease, not of it. I spend a great deal of time thinking about who we do not need to treat. It is not that they need less aggressive therapy, but that they need no treatment. My hope is that focal therapy will be the right treatment, for the right patient, with the right kind of cancer. – by Jennifer Southall

For more information:

Adam Kibel, MD, can be reached at Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115; email: akibel@partners.org.

Disclosure: Kibel reports no relevant financial disclosures.