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Drs. Alex Parker (left) and Todd Igel are studying how accurately template biopsies can identify tumor locations.
In the fall of 1999, Mayo Clinic urologist Dr. Todd Igel had a revelation. After dealing time and time again with negative biopsies on patients with significantly elevated prostate-specific antigen (PSA) tests and knowing that these biopsy results were false negatives due to inadequate tissue sampling, Igel had a thought.
What if a process commonly used to treat prostate cancer could be modified to better detect it? Brachytherapy is a procedure in which radioactive seed implants are inserted into the prostate to destroy cancerous cells. The procedure is performed with the use of a template grid that allows better access and orientation to the prostate gland so the physician can place the seeds with greater precision.
"I discussed the protocol with my Mayo colleagues and Dr. Robert Moreno, a community urologist who also was instrumental in the idea's development," says Igel. "We wondered — if we can use it to put seeds into the prostate, why can't we use it to take something out?" Igel says.
He gave the new biopsy technique a name — transperineal ultrasoundguided template biopsy. With his colleagues, he tested it on a group of men who were considered at high-risk for prostate cancer — those with elevated PSA scores but negative results from multiple transrectal biopsies. The results were remarkable. Cancer was found in 43 percent of the study participants, which meant early treatment and a better prognosis for all of them.
"We've now been doing the template biopsy for five years," says Igel. "We've published two articles on this technique in well-known urology medical journals, and it's used by many urologists all over the world. On average we find cancer in 37 to 40 percent of patients at risk for prostate cancer."
About 500 of these biopsies have been performed at Mayo Clinic in Jacksonville. Doctors in Japan and Italy also have published findings from their successful experiences with the method.
With such success, Igel says his group is now looking at other ways the template system might help patients.
"We think it can provide a roadmap for delivering all types of treatments, such as cryotherapy, radiation therapy and ultrasound therapy, in much more targeted, focused ways," Igel says. Focused treatments could have a major impact in reducing side effects such as incontinence and sexual dysfunction.
Cancer epidemiologist Dr. Alex Parker is working with Igel to determine how accurate the template biopsy is at pinpointing the location of tumors.
"We know that this technique can find tumors that are missed by other biopsy methods," Parker says. "What we need to know now is how good this method is at telling us the actual location of these tumors within the prostate itself. It's only half the battle to know a tumor is there. We need to know its exact location if we're going to target it."
The two also are working with others in the Department of Urology to build a comprehensive database registry of patients with prostate cancer. When completed, the database will include detailed information and specimens from patients treated for prostate cancer at Mayo Clinic in Jacksonville since 1992. Studies analyzing the data from this registry will bring a new level of detail to patient care, Parker says, one that currently doesn't exist for prostate cancer.
"When the database is complete, we'll be able to use it to tell patients how others the same age, with the same clinical features and tumor type, did with the various treatment strategies," he says. "It's especially important for prostate cancer, where quality of life after treatment has become a major issue."
Info:
Department of Urology
(904) 953-7330
Learn more about the treatment of prostate cancer at Mayo Clinic in Jacksonville.
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