During a man's lifetime, odds are one in seven that he be diagnosed with prostate cancer. If it's a slower growing form detected in later years, he may live out a normal life span and die with it, but not from it.
However, if his cancer is more aggressive, even a young man could be the one in thirty-nine who dies of prostate cancer. It's second only to lung cancer as the leading cause of cancer deaths in men. Last year, over 200,000 new cases were diagnosed in the U.S.
For a man facing this challenge, there is not only the threat to life and health, but also concerns about the possible effects of treatment on other health functions, his closest relationships and how he sees himself. As of now, in the United States, fighting prostate cancer typically means treating the entire prostate to be sure of eliminating malignant cells. The treatment can be life saving, but it can also affect other physical functions and have a psychological and social impact on the patient himself as well as those who love him.
However, a new image-guided robotic tool could soon make a tremendous difference in how prostate cancer is detected and treated. Now in beta testing at UAB, the new technology is being developed to allow precision targeting of lesions for earlier diagnosis, and potentially new, minimally invasive approaches to treatment in the future.
The iSR'obotTM Mona Lisa robotic platform created by Biobot Surgical uses magnetic resonance imaging and ultrasound fusion techniques to robotically guide biopsy of suspicious lesions. The system's fusion software helps with the localization of the needle when a biopsy procedure is performed, providing precision accuracy.
UAB's Urologic Oncology Innovations Lab was selected as the second site in the United States to begin preclinical testing to determine utility for potential clinical use and to prove the principle that biopsies can be performed with spacial accuracy of targeted regions. Information gathered during testing will also be used in fine-tuning the platform for future treatment applications.
"In the first phase, we're working with phantoms, which are standard models made from a gelatinous material with simulated lesions embedded," lead investigator Soroush Rais-Bahrami, MD said. "A diagnostic MRI is taken before the procedure is fused with real time ultrasound imaging to give us a 3D view so we can use the robot to place a biopsy needle exactly where a suspicious image is located.
"In phase two, we will be working with Biobot Surgical to develop personalized 3D molds based on actual patients for patient-specific focal therapy planning. These molds will also help with biopsy and surgical training for residents, fellows and practicing physicians."
Along with Rais-Bahrami and his co-investigator Jeffrey Nix, MD, a multidisciplinary team from UAB's Program for Personalized Prostate Cancer Care is involved in evaluating the new robotic tool and the impact it could have on advancing diagnosis and treatment. Experts from urology, radiology, radiation oncology, medical oncology and pathology are working together to determine the best treatment pathway for each individual patient with prostate cancer.
The evaluation, which began last spring, is supported by a pilot grant from Biobot Surgical and BK Medical Systems.
"We've been very happy with the platform's performance thus far, and the company has welcomed suggestions based on what we learn as we work with the system," Rais-Bahrami said. "Our team's input on the device will help to shape the future of prostate cancer diagnosis and treatment, not only for our patients at UAB but also for patients worldwide. The feedback we provide will help make the already-successful robot better as it launches in the United States for research and clinical implementation."
As the work progresses, the team will be looking at strategies for modifying the devices to use with different energy modalities including heat, cold, ultrasound and microwave that could be used in precision ablation of malignancies.
"Ultimately, the goal is to develop minimally invasive focal therapies that will allow faster recovery and help preserve as much function as possible," Rais-Bahrami said. "The device should also be helpful in accurately determining the aggressiveness of the cancer to guide individual treatment planning so we can offer each patient the best personalized care."
More than a thousand patients across Europe and Asia are already receiving biopsies with the Mona Lisa robotic device. Following FDA approval of the platform's fusion software, UAB researchers are looking forward to beginning clinical trials that could benefit biopsy-qualified prostate cancer patients.