An essential aspect of effective cancer treatment is knowing when it is best to aggressively treat a patient’s cancer and when treatment can be safely avoided. Tools that can be used to accurately assess the risk posed to a patient are essential in that decision-making process. A clinical trial at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, is studying technology to help physicians accurately identify which tumors are likely to progress and require treatment and which are not.
The MRI-Guided Active Selection for Treatment of Prostate Cancer, or the Miami MAST Trial, headed by principal investigator Sanoj Punnen, M.D., a board-certified urologic oncologist at Sylvester and associate professor of urology, focuses on the one-third of men with prostate cancer who have tumors that grow so slowly they are placed under “active surveillance” by their physicians. In collaboration with the National Institutes of Health and the National Cancer Institute, the Sylvester group is using the newest technologies to determine which tests most accurately predict the best candidates to observe and the best to treat.
The clinical trial involves multi-parametric MRI (MP-MRI) ultrasound or direct MRI-guided biopsies and tracks their relationship to historic transrectal ultrasound (TRUS)-guided biopsy rates. The research team is also trying to identify high-risk tumors early enough to reduce the proportionate number of patients who may have a poor response to delayed primary treatment.
“We are also looking at radiomics signatures from MP-MRI to define patterns associated with progression,” said Dr. Punnen. “The genomic signatures, based on RNA from tumor tissue, define patterns associated with habitats, radiomics signatures, and progression.”
In addition, researchers are investigating the impact of MRI and MRI-US fusion biopsy to identify higher grade or volume tumors early on for a better selection of patients for active surveillance, as well as improved outcomes for patients undergoing delayed treatment after an initial observation.
The research focuses on achieving a more direct sampling of tumors from compartments that have distinct MP-MRI characteristics that increase the “progression” on early first or second surveillance biopsies and decrease the rate of “progression” on third and fourth surveillance biopsies.
Dr. Punnen is also involved in researching imaging, molecular, and genomic markers that play a role in the diagnosis and prognosis of prostate cancer, as well as trends in the incidence and management of the disease that affects millions of men in the United States.
“Prostate cancer takes a physical and emotional toll, and our greatest satisfaction is knowing that our research has real meaning and will make a difference in the lives of patients,” said Dr. Punnen. “One of the greatest benefits of working at UHealth is that we are constantly evolving with new technology. The combination of our clinical care and research expertise ultimately provides patients the best possible outcomes.”
The study is expected to be completed in October 2020. The trial is being funded by grants from the National Institutes of Health.