February 4, 2021
Multidisciplinary research group demonstrates that using MRI and targeted biopsies can avoid unnecessary prostate biopsies in a third of men and reduce the diagnosis of insignificant cancers
Determining whether a patient with prostate cancer requires aggressive therapy or active surveillance is a challenge. Current tests can detect early signs of prostate cancer, but these tests can lead to many unnecessary and painful biopsies for patients whose disease never becomes aggressive.
In an OICR-funded Phase III clinical trial, researchers have found that using Magnetic Resonance Imaging (MRI) and MRI-guided biopsies as needed, can reduce the number of unnecessary prostate biopsies and the diagnosis of insignificant cancers. The study results were recently published in JAMA Oncology.
The study, called the Prostate Evaluation for Clinically Important Disease: MRI vs Standard Evaluation Procedures (PRECISE), included 453 participants at cancer centres across Canada who were assigned to either the current standard of care – a systematic transrectal ultrasound-guided (TRUS) biopsy – or a new method – MRI with MRI-guided biopsy as needed.
The study demonstrated that using MRI and MRI-targeted biopsies caught clinically significant cancers as effectively as conventional TRUS biopsies, but reduced the rate of men undergoing biopsy by almost 40 per cent. The MRI method also halved the number of unnecessary diagnoses of slow growing, clinically insignificant cancers. Additionally, those who did have biopsies in the MRI arm had significantly fewer samples taken relative to those in the TRUS biopsy arm, meaning fewer needles and less pain and discomfort for patients.
These clinical data show the revolutionary impact of the use of prostate MRI in cancer diagnosis and surveillance.
“Approximately one in eight men will be diagnosed with prostate cancer in their lifetime,” says the study’s lead statistician and OICR Investigator, Dr. Greg Pond, who is also an Associate Professor at McMaster University and Senior Biostatistician at the Ontario Clinical Oncology Group. “These clinical data show the revolutionary impact of the use of prostate MRI in cancer diagnosis and surveillance.”
“Using our current standard methods, we recognize that we are overdiagnosing some prostate cancers, leading to unnecessary biopsies and treatments,” says co-lead of the study, Dr. Masoom Haider, Head of the Radiomics and Machine Learning Research Lab at the Lunenfeld-Tanenbaum Research Institute, Professor at the University of Toronto, and OICR Clinician Scientist. “Through PRECISE, we’ve demonstrated that using MRI and MRI-targeted biopsies as an alternative to standard biopsies, can effectively detect clinically significant cancers, but avoid overdiagnosing clinically insignificant cancers. This means reducing the number of needles or eliminating biopsy altogether if a patient doesn’t need it. For our health system, this alternative may present an opportunity to use our resources more effectively.”
Haider has played a leading role in integrating the PRECISE findings into Cancer Care Ontario (CCO) guidelines for prostate cancer management. The study’s findings influenced CCO’s Prostate MRI Guideline 27-2 and will be implemented this year, meaning more prostate cancer patients across Ontario may be spared unnecessary biopsies and treatment thanks to MRI and MRI-targeted biopsies.
September 20, 2019
Ottawa cancer researchers and clinicians embrace the window of opportunity between a cancer diagnosis and treatment with a coordinated approach to clinical research
The time between a patient’s cancer diagnosis and their surgery presents a valuable “window of opportunity” to evaluate new treatment strategies. Short-term clinical trials during this period – also known as window of opportunity trials, window trials or phase 0 trials – can help researchers gain insights into the effects and the efficacy of a new potential treatment. Dr. Angel Arnaout at The Ottawa Hospital is putting window trials into practice.
“There are many nervous and anxious moments between diagnosis and their surgery but patients have limited options during this time,” says Arnaout.
“We saw an opportunity in this window of time to take action. We saw that we could help support patients who are waiting for surgery, while helping future patients through accelerating clinical research.”Dr. Angel Arnaout
Arnaout, a surgical oncologist who specializes in breast cancers, assembled a cross-disciplinary team of medical oncologists, pathologists and other clinical research specialists at The Ottawa Hospital to strategically design and implement this new approach. They would collectively establish common priorities, decide on which interventions would be tested and work to streamline the patient’s journey throughout the process.
Together, the team was motivated by the mutual benefits of all stakeholders involved. Namely, window trials can provide patients an opportunity to contribute and engage with cancer research while potentially improving the state of a patient’s disease. Meanwhile, these trials could ultimately expedite drug development by improving the understanding of a potential drug early in its development.
The team launched their first study in 2014, which found that patients were exceptionally eager to participate, and since then, launched and completed three additional window trials.
The first was a breast cancer trial on presurgical hormone therapy that helped establish the capacity and infrastructure for enrolling patients, organizing the investigations and giving patients short-term therapies. The second tested a potential cancer-fighting agent, chloroquine, and found that it had no effect on stopping breast cancer proliferation. The third trial debunked the idea that vitamin D – even at very high doses – can slow down the growth of breast cancer.
“These studies didn’t uncover a new therapy, but they did help us answer important questions that patients have, like ‘Will taking vitamin D help?’” says Arnaout. “These types of studies also provide a relatively quick method to test whether we should continue research into a particular avenue.”
The group at The Ottawa Hospital has recently teamed up with researchers from OICR to initiate a new breast cancer window-of-opportunity study to examine biomarkers of efficacy and resistance for another new drug candidate. The trial is planned to begin recruitment by mid-fall this year.*
Despite the benefits of these trials, Arnaout adds, it is still important to reduce unnecessary delays between diagnosis and surgery. Arnaout continues to minimize these delays at The Ottawa Hospital.
“We try our best to reduce wait times, but if patients have to wait – we can try to help them in the meantime while accelerating breast cancer research.”
*This new trial is co-led by Dr. John Hilton from The Ottawa Hospital and Dr. John Bartlett from OICR. Co-investigators include Drs. Laszlo Radvanyi, Melanie Spears, Arif Ali Awan, Mark Clemons, Greg Pond and Angel Arnaout.
April 9, 2018
Dr. Gregory Pond, Jenna Sykes, Dr. Richard Cook, Yonathan Brhane, Dr. Wei Xu.
Cancer researchers often confront quantitative challenges and puzzles that are best addressed by biostatisticians – specialists in a field for which there is a growing demand. In a 2008 survey of Ontario oncologists, eight in 10 respondents identified the lack of trained biostatisticians as a factor limiting their progress in cancer research. OICR has recently renewed funding for the Biostatistics Training Initiative (BTI) following a successful review. With this funding, the BTI will continue to benefit Ontario’s cancer research community and develop the next generation of cancer biostatisticians. The BTI is run in partnership with in the University of Waterloo and McMaster University.
February 26, 2016
This meeting sets stage for next four years of biostatistics training
As the cancer research landscape rapidly changes, so to do the needs of hospitals and research institutes for the types of young researchers on their teams. New technological advances have led to the need for qualified biostatisticians who can work with the large amounts of data that are now an essential part of many cancer research projects.