New research is paving the way for enhanced treatment of prostate cancer

Theranostics has so far only been used as a last treatment option in prostate cancer.

A key question is whether it is also beneficial in treating earlier stages of prostate cancer. Professor Mark Frydenberg AM is pursuing research that will answer this important question.

Theranostics is a personalised approach to treating prostate cancer, that uses PET scan imaging (a special type of scan) to see if the tumour biomarker, prostate-specific membrane antigen (PSMA), is present on tumour cells. Peptide receptor radionucleotide therapy (PRRT) such as Lutetium-PSMA-177 (177Lu-PSMA) is then administered via a patient’s bloodstream. The 177Lu-PSMA targets and binds the prostate cancer cells identified by the PET scan, killing the cancer cells wherever they are in the body, while also limiting the impact on healthy cells.

Although currently not approved for use in Australia, clinical trials have shown promising results for 177Lu-PSMA to control disease progression in metastatic prostate cancer. However, these studies have only used 177Lu-PSMA in late stages of treatment. A new clinical trial, UpFrontPSMA, being led at Cabrini by Prof Frydenberg, in collaboration with the Peter MacCallum Cancer Centre, will investigate if receiving 177Lu-PSMA earlier in the prostate cancer disease trajectory can more effectively eradicate metastatic disease.

UpFrontPSMA trial

For more than 50 years, the most common treatment for newly diagnosed metastatic prostate cancer has been surgical or medical castration via androgen deprivation therapy (ADT). In recent years, the strategy has changed to incorporate the earlier use of therapies including docetaxel chemotherapy, which has been shown to significantly improve clinical outcomes when added to ADT. However, even with the addition of docetaxel, progression to lethal metastatic castration resistant prostate cancer remains inevitable in nearly all patients. The UpFrontPSMA trial will investigate the early use of 177Lu-PSMA in addition to docetaxel to determine if the combined therapy approach can more effectively eradicate disease and improve outcomes for patients.

“We are really interested to see the outcomes from the UpFrontPSMA clinical trial. Not only does it have the potential to offer a new therapy strategy for patients, but it will also guide our research in using theranostics in even earlier stages of prostate cancer, before ADT hormone treatment commences,” said Prof Frydenberg.

“We are desperately in need of treatment options for patients with metastatic prostate cancer, to improve their outcomes, and their quality of life.”

A new painless and minimally invasive surgical technique used in the treatment of prostate cancer

Irreversible Electroporation (IRE) therapy, also known as NanoKnife or focal therapy, is a new advance in the surgical treatment of prostate cancer. Painless and minimally invasive, IRE uses short duration, focused electric pulses to kill cancer cells, leaving surrounding healthy cells untouched and lessening side effects. Still in the early stages of development, and only accessible to patients with end stage prostate cancer, Prof Frydenberg’s team are undertaking research on the use of this technology, its ability to effectively kill cancer cells (based on blood test response, MRI and prostate biopsies), its side effects (ideally demonstrating reduction in the side effects of erectile dysfunction and incontinence based on validated questionnaires), its ability to salvage failed radiation therapy in those who chose radiation as their primary treatment, and the ability to safely salvage the situation with conventional treatments such as radiation therapy or surgery, if the treatment is unsuccessful.

Patient access to IRE therapy at Cabrini, and Prof Frydenberg’s research, would not have been possible without the generous support of numerous donors. Their funding has enabled Cabrini to purchase the IRE machine and support Prof Frydenberg to undertake critical research needed to advance its use in the treatment of prostate cancer.