The Prostate Centre at the Princess Margaret continues to make unique and significant advances in clinical care and research programming. Today, the Princess Margaret offers a unique and comprehensive program across the trajectory of the disease that personalizes cancer care from prevention to survivorship.
In addition to the world-class standard care procedures, the Princess Margaret also offers prostate cancer patients unique areas of innovative research-based treatments:
The Prostate Cancer Prevention Clinic is at the forefront of research and practice. Our blood collection sample has evolved into the Genito-Urinary (GU) Bio Bank - a repository of tissue samples that contain biomarkers for disease that are helping researchers to better identify those who are at risk for prostate cancer, the aggressiveness of the disease, and the best course of treatment.
The Prostate Centre Database has become the only outcomes-based database for prostate cancer in Canada. Information regarding patient demographics, disease characteristics, treatments, cancer control, quality of life, and emotional wellbeing are collected. Combined, the GU BioBank and the Prostate Centre Database provide invaluable information to our healthcare team, maximizing prevention, treatment effectiveness, and minimizing side effects.
The future of surgical treatment of prostate cancer is being developed at the Prostate Centre through the combined efforts of the surgical and radiation oncology teams. MRI Targeted Focal Laser Therapy is a new, minimally invasive treatment for localized prostate cancer in men that would otherwise choose active surveillance as their treatment plan. This treatment is reducing the risk of missing the window for treatment of prostate cancer, and results from recent clinical trials show minimal need for pain medication and minimal side effects.
For men requiring radical prostatectomy, the latest advancement in surgical technology for prostatectomy is taking place at the Princess Margaret. Robot-assisted Laparosopic Radical Prostatectomy is helping surgeons to perform this delicate surgery with less damage to surrounding structures. The DaVinci robot uses advanced optics that magnify the surgical field by 10 times and creates 3D images of the prostate and surrounding nerves and tissues. Its robotic arms eliminate even the slightest hand tremors, and the 'wrists' on the robot allow greater range of motion than the human hand. The result is better outcomes for patients with less need for narcotics post-operatively, and fewer side effects.
The researchers at the prostate centre are looking into the genetic markers for prostate cancer - BRCA1 and BRCA2. These genetic mutations increase the risk of developing prostate cancer, and may provide information on how prostate cancer develops. In collaboration with the GU BioBank and Prostate Centre Database, our genetic researchers are also comparing the nature of BRCA1/2 cancer with other familial or sporadic type cancers to see if there are any differences.
Dr. Robert Bristow is also leading the Canadian Prostate Cancer Genome Network (CPC-GENE) - a 5-year, $20 million research initiative (funded by Prostate Cancer Canada, and the Ontario Institute for Cancer Research). This unique, pan-Canadian initiative is an effort to crack the prostate cancer genetic code by determining the DNA mutations in prostate cancer. Using state-of-the-art DNA sequencing technologies, this team of Canada's top oncologists and cancer biologists will identify mutations that predict failure following surgery, radiation therapy, and hormone therapy.
The Prostate Centre researcher Dr. Gang Zheng is currently using the science of nanotechology to create substances resembling colourful balloons that are the size of molecules that could be filled with drugs to deliver cancer-fighting medicine to very specific targets - like a cancerous cell.
The nanoparticles are completely non toxic and biodegradable and are light-activated when in the body. When the nanoparticles hit their target, they become fluorescent indicated successful targeting of the cancer. Then, the team uses a laser to activate the nanoparticles and rapidly heat and kill the tumour.
Dr. Neil Fleshner is examining Dutasteride, a common drug used to treat benign prostate enlargement, as a possible method for preventing cancer progression in men who elect to use active surveillance as their treatment strategy. His Phase III trial showed that Dutasteride can provide significant benefits to men who elect to have their prostate cancer observed.
Dr. Fleshner is also exploring the potential of a common and inexpensive diabetic drug, called Metformin, to help prevent prostate cancer. He is working with the Canadian Cancer Society to explore if diabetics who take this drug are at a lower risk of developing prostate cancer. If his studies continue to show promise, a formal randomized controlled trial of Metformin for specific at-risk populations will be conducted.
Dr. Ian Tannock is currently research a way to improve growth delay in metastatic castration resistant prostate cancer (CRPC) tumours. His goal is to find a way to increase the frequency and duration of response to first line chemotherapy treatments with minimal increase in toxicity. If the chemotherapy could be more effective, it would lead to improved survival and palliation for men with CRPC.
The lab already has phase I data showing that high IV doses of a drug called pantoprazole (PTP) can be combined safely with chemotherapy. The proposed phase II trial would evaluate whether there is sufficient evidence for enhancement of the currenly chemo standards to proceed to phase III study.
The radiation oncology team at the Prostate Centre led by Dr. Charles Catton is focused on using new technology to improve the precision and accuracy of prostate cancer radiotherapy. Targeting and delivering radiotherapy onto the prostate is very complex. Lack of precision may lead to increased side effects and even a failure to control the cancer.
To this end, cone beam radiotherapy was developed and commercialized by Princess Margaret researchers. The team has seen success with this high-precision radiotherapy technique - it has not only allowed them to increase precision, but also deliver a higher dose of radiation with fewer adverse side effects. They are now hoping to develop the technique further to allow radiotherapy to be applied for longer periods of time to increase the effectiveness of treatment.
The Prostate Centre has developed the Psychosocial Support Program offering psychotherapy and emotional support to newly diagnosed prostate cancer patients and their families. This support is available throughout the disease trajectory. The Prostate Centre's on-staff psychologist, Dr. Andrew Matthew, and his team have developed innovated bio-psychosocial interventions to help patients deal with the shock, fear, and uncertainty associated with diagnosis as well as the common side-effects to PC treatment.
These efforts have led to the development of the Prostate Cancer Nutrition program providing preventative and complementary nutrition information to men at risk for prostate cancer or going through prostate cancer treatments. The nutrition program is offered alongside the Survivorhsip Exercise Program which is based on evidence that exercise is beneficial for patients during and after treatment. Daniel Santa Mina is conducting research on the effects of exercise during prostate cancer treatment to improve services.
The Prostate Cancer Rehabilitation Clinic is providing a unique bio-psychosocial intervention for men who are suffering from the common side effects of surgical prostate cancer treatment.