Prostate cancer is the most common non-skin cancer among American men. One man in seven will be diagnosed with prostate cancer in his lifetime. Yet with new treatments and screening technologies being developed all the time, more than 2,000,000 men in America can call themselves prostate cancer survivors.
Researchers at Yale are conducting many clinical trials surrounding all aspects of prostate cancer diagnosis and treatment. Daniel Petrylak, MD, professor of Medicine (Medical Oncology) and of Urology and co-director of the Signal Transduction Research Program is currently leading several trials aimed at examining new treatments in men with high risk and metastatic prostate cancer, which are open for enrollment.
Some early stage trials are also under way which test a new and innovative imaging technology that has the potential to be the future of prostate cancer care. Yale was the first medical center in New England to use Magnetic Resonance Imaging (MRI) ultrasound fusion targeted biopsy in diagnosing prostate cancer, or targeted MRI. This type of imaging “is a much more accurate way of doing a biopsy than the traditional method,” says Assistant Professor of Urology Preston Sprenkle, MD, whose research focuses on using imaging technology to improve prostate cancer diagnosis. “Prostate cancer is very common and current treatments can majorly impact a man's sexual and urinary function,” says Sprenkle. “Exciting technological advances are revolutionizing urology.”
Three current clinical trials at Yale that are open to enrollment are testing new ways to improve the diagnosis of prostate cancer. One of the ongoing trials involving the uses of this cutting-edge strategy of targeted MRI is open to men who have been diagnosed with low-risk prostate cancer. Low-risk prostate cancer has a very low likelihood of causing problems, and is often minimally treated, or not treated at all. The trial aims to identify if it is possible to use targeted MRI in some men with this type of prostate cancer to predict whether their cancer may worsen and need future treatment.
Exciting technological advances are revolutionizing urology.
Assistant Professor of Urology, Preston Sprenkle, MD
The second trial is for men with a breast cancer mutation, known as a BRCA2 deletion. This screening study aims to help men with this mutation get evaluated and tested for prostate cancer, as some men with a BRCA2 mutation have been shown in some studies to have a significantly higher risk of prostate cancer, and have worse prostate cancer when it has diagnosed. There have not many studies to date to determine if men with a BRCA2 mutation should be more aggressively screened for prostate cancer.
“If men with the mutation are at higher risk, we are trying to determine if we should begin discussing treatment at an earlier point than we would with men without it,” says Sprenkle. Traditionally, PSA, or prostate-specific antigen is the common test used to diagnose prostate cancer in men. “We screen using PSA in all men,” says Sprenkle, “but maybe there is something additional we should be doing in men who are at higher risk through the mutation.”
Sprenkle is also a pioneer in “focal therapy,” which allows a surgeon to treat tiny prostate lesions, rather than the whole organ. This avoids many of the side effects—such as erectile dysfunction and incontinence—that may follow the removal of the whole prostate. Another open treatment trial examines the effectiveness of focal therapy in carefully selected men with low or intermediate-risk prostate cancer. “Targeted MRI allows us clarity about where this cancer is located in the prostate,” says Sprenkle, so focal therapy can be used to treat only the impacted area, and minimize side effects.