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Memorial Sloan Kettering Cancer Center (MSK)
The future for prostate cancer is here with PSMA, MRI-Guided Radiation, and High-Intensity Focused Ultrasound Prostate cancer therapies. Let’s take a look at each.
FDA Approves Promising Therapy for Advanced Prostate Cancer: Targets a Protein Called PSMA
Prostate cancer treatment took a major step forward today as the U.S. Food and Drug Administration approved a new therapy that zeros in on cancer cells to destroy them. The treatment, called 177Lu-PSMA-617, uses a molecule that selectively seeks out and attaches to a specific protein on the cancer cell surface called PSMA (prostate-specific membrane antigen). The technology delivers radiation that damages DNA and destroys the cancer cell.
“This type of precision medicine is a game changer for people whose prostate cancer has spread despite receiving multiple treatments,” says Memorial Sloan Kettering Cancer Center medical oncologist Michael Morris. He helped design, execute, and analyze a clinical trial showing the effectiveness of 177Lu-PSMA-617. “FDA approval of this therapy will enable even more people who had essentially been given death sentences to survive and live well.”
This treatment, developed by the pharmaceutical company Novartis, could be a breakthrough for treating prostate cancer after it has spread and grown resistant to other drugs. Prostate cancer is the second leading cause of cancer death in American males and kills 34,000 people in the U.S. every year.
The FDA approval is the latest bold advance in the emerging field of theranostics, which uses radioactive substances to visualize cancer cells and destroy them without harming normal cells. It also enables doctors to determine how well a treatment is actually working.
“We have a theranostic motto, which is ‘We see what we treat, and we treat what we see,’ ” says nuclear medicine physician Lisa Bodei, Director of Targeted Radionuclide Therapy at MSK. She is an expert specializing in using radioactive materials to diagnose and treat cancer and played a key role in the treatment of MSK participants in the trial.
The clinical trial, called VISION, showed that adding the drug to standard treatment slowed the progression of prostate cancer. Dr. Morris presented results from this trial in June 2021 at the annual meeting of the American Society of Clinical Oncology. The results also were reported in The New England Journal of Medicine.
Key Takeaways
- A new FDA-approved drug could be an effective treatment against prostate cancer that has spread
- The treatment uses a molecule that seeks out and attaches to a specific protein on the cancer cell surface called PSMA
- The technology delivers radiation that damages DNA and destroys the cancer cell.
High-Intensity Focused Ultrasound (HIFU) Can Control Prostate Cancer With Fewer Side Effects
In recent years, a new treatment strategy known as focal therapy (partial gland ablation) has emerged for prostate cancer considered to be “intermediate risk”—mostly, small tumors confined to one area of the prostate. At Memorial Sloan Kettering Cancer Center (MSK), researchers have been working closely with an advanced focal therapy approach known as high-intensity focused ultrasound (HIFU), guided by magnetic resonance imaging (MRI).
Now a landmark clinical trial has demonstrated this less-invasive method works well for many patients. The phase 2 trial, led by MSK urologic cancer surgeon Behfar Ehdaie, looked at a particular type of HIFU treatment, also called MR-guided focused ultrasound (MRgFUS), in men with intermediate-risk cancer. The novel approach effectively controlled the disease in patients and greatly reduced adverse side effects of treatment. This suggests many men with intermediate-risk prostate cancer can avoid surgery, chemotherapy, and radiation.
How Does HIFU for Prostate Cancer Work?
The MR-guided focused ultrasound (MRgFUS) is an outpatient treatment that takes about two hours. Patients under anesthesia are placed in an MRI machine covering the body’s lower half. After the machine takes an image of the prostate, the doctors outline the treatment area and deliver the focused ultrasound waves, guided by the MRI. The ultrasound waves come from different directions, intersecting to attack and kill the cancer by heating the cells to more than 158 °F (70 °C).
While you are imaging, you are getting temperature feedback as well to make sure the right spots are being treated,” Dr. Ehdaie says. “The patient wakes up from the anesthesia and goes home. There’s no incisions or wounds on the body to heal. We have demonstrated the procedure is safe for patients, and they can return to normal activity right away.”
In phase 2 of the clinical trial, 101 men received the novel MRgFUS treatment and then were biopsied six months and 24 months later. There was no intermediate- or higher-risk cancer left in the treated area for 88% of the patients.
“Probably most important was the lack of side effects,” Dr. Ehdaie says. “Nobody in the study reported urinary incontinence or experienced bowel problems. Most men were able to achieve erections.”
Based on this data, in December 2021 the FDA granted approval for the technology, called Exablate Prostate, to treat prostate tissue. The FDA also approved an investigator-initiated trial designed by Dr. Ehdaie and surgeon Peter Scardino to compare MRgFUS focal therapy to active surveillance and demonstrate a clinical benefit for patients with prostate cancer.
New MRI-Guided Radiation for Prostate Cancer Destroys Tumors With Great Precision
In the phase 2 clinical trial, 101 men received the novel MRgFUS treatment and then were biopsied six months and 24 months later. There was no intermediate- or higher-risk cancer left in the treated area for 88% of the patients.
“Probably most important was the lack of side effects,” Dr. Ehdaie says. “Nobody in the study reported urinary incontinence or experienced bowel problems. Most men were able to achieve erections.”
Based on this data, the FDA in December 2021 granted approval for the technology, called Exablate Prostate, to treat prostate tissue. The FDA also approved an investigator-initiated trial designed by Dr. Ehdaie and surgeon Peter Scardino to compare MRgFUS focal therapy to active surveillance and demonstrate a clinical benefit for patients with prostate cancer.
This treatment is suited to Alexandros’ specific type of prostate tumor — a dominant intraprostatic lesion (DIL), which is visible on an MRI and confined to one spot in the prostate. These cancers tend to be aggressive and have a high rate of recurrence in the same spot. An extra-high dose of radiation could prevent the cancer from coming back.
The MRI-guided treatment represents the latest advance in radiation therapy pioneered at MSK using precisely targeted, intense radiation doses split into fewer sessions. Over the past decade, MSK doctors have used an approach, called MSK Precise®, to greatly reduce the number of radiation treatments needed for certain prostate cancer patients. It relies on MRIs rather than CT scans.
When it comes to treatment for prostate cancer, men now have many good options that have improved prognoses for the disease.
Surgery: MSK prostate surgeons are among the most experienced in the U.S. Research studies have examined the track records of surgeons who regularly perform radical prostatectomies (removal of the prostate). This research shows these surgeons have fewer complications on average than surgeons who do these surgeries less often. Many of our prostate cancer surgeons focus only on prostate cancer. Their deep knowledge and experience mean they can give you care with the best outcomes.
Radiation Therapy: Radiation oncologists, medical physics experts, and radiologists work closely to provide a comprehensive treatment plan. Recent research studies show patients have better outcomes when treated by an experienced radiation oncology team specializing in prostate cancer.
Many prostate cancers diagnosed today are indolent (grow slowly). They grow so slowly that they probably will not cause symptoms, spread, or shorten your life in any way. Each case of prostate cancer is different. The cancer you have may change over time. Seek an expert who will learn what kind of cancer you have and talk with you about the options best for you. Sometimes they may recommend that you do not have surgery or radiation therapy right away. Instead, carefully monitor the cancer’s growth. Better to address it than not!
As one of the world’s most respected comprehensive centers devoted exclusively to cancer, MSK has been recognized as one of the top two cancer hospitals in the country by U.S. News & World Report for more than 30 years.
