Daily Mail - 13.08.2019

Page 46 Daily Mail, Tuesday, August 13, 2019

By SOPHIE

GOODCHILD

3D scan is the smart way to

target tiny prostate tumours

Treatment: David Beale

urological surgeon from Uni­

versity Hospital Southampton,

says: ‘Targeting tumours can

be difficult, but the evidence

shows this system makes that

much easier and reliable. Fewer

biopsies can be taken — and

SmartTarget is user­friendly.’

With more than 46,000 new

cases a year, prostate cancer is

the most common cancer in

British men.

A biopsy of the prostate, a

walnut­sized gland underneath

the bladder, can confirm the

disease — but ultrasound scans

used to decide which pieces

of the prostate to sample can

be unclear, leaving the doctor

effectively working blind.

As a result, half of life­

threatening cancers are

missed and healthy tissue can

be removed, which sometimes

leads to impotence. Ultrasound

biopsies can also be painful and

invasive, especially if the doctor

has to take several samples.

T

He SmartTarget

system — developed

at University College

London — provides

detailed images, allowing the

doctor to home in quickly on

suspect areas. It is already

being used in hospitals and

combines detailed pre­biopsy

MRI scans with real­time

ultrasound images, providing

unprecedented views.

‘It’s like a fighter pilot getting

images from an augmented

reality cockpit display,’ says

Professor Mark emberton, an

honorary consultant at Univer­

sity College London Hospitals

NHS Foundation Trust, who

has been involved in the

development of SmartTarget.

SmartTarget first uses

multi­parametric MRI, which

combines three types of MRI

scan, to produce highly detailed

images of the prostate.

It is more sensitive than

traditional MRI in detecting

small tumours that could none­

theless be very dangerous.

SmartTarget software then

uses the scan to create a 3D on­

screen model, where abnormal

tissue shows as yellow.

When the biopsy begins, an

ultrasound is done as usual,

and these ‘live’ images are

superimposed on to the model.

This lets the doctor quickly and

easily find areas of concern.

Without the latest technology,

a doctor couldn’t simultaneously

perform a biopsy and MRI scan

— because the patient would

be inside the scanner.

So, traditionally, the MRI is

done before the biopsy — the

doctor then analyses the

images, calculates the area to

target, and, during the biopsy,

refers back to the MRI image.

As this requires six months’

training and practice, some

hospitals lack staff with the

necessary skills. Ultrasound

scanning with a probe is

comparatively straightforward.

With the dual scanning

system, crucial details are also

provided, such as the size,

shape and exact position of the

tumour within the prostate,

which an ultrasound alone

would not provide, nor in such

detail using a traditional MRI.

And, unlike with ultrasound or

standard MRI, the biopsy is

carried out through the skin in

the area between the patient’s

testicles and back passage,

rather than the usual route

through the back passage, as

it is more targeted.

Cancer detected can then be

destroyed using high­intensity

focused ultrasound (HIFU),

a relatively new, but very

accurate, technique using ultra­

sonic waves to heat up cancer

cells and kill them without

destroying healthy tissue.

The SmartTarget model can

be adjusted to accommodate

the patient moving, ensuring

greater accuracy during biopsy

and treatment.

Retired surveyor David Beale,

70, underwent SmartTarget as

part of a trial. He was diagnosed

with prostate cancer in 2010

after complaining to his GP of

bladder infections, a common

symptom. Doctors suggested

delaying treatment, because a

traditional biopsy suggested

his was a slow­growing cancer.

They continued to monitor him

with blood tests, an approach

known as ‘watchful waiting’.

However, over the years, these

tests revealed that his levels of

PSA (prostate­specific antigen

protein), made by the prostate

and potentially indicating

cancer, were increasing.

In 2016, David joined the

SmartTarget study, which

revealed some of his cancer was

faster­growing. The same year,

he joined another trial, where

patients were given an injection

of artificially created bacteria,

PRX302, to activate PSA to

target and destroy the cancer.

‘This reduced my tumour to a

level where it was unlikely to

kill me — unfortunately, though,

the improvement was only

temporary,’ says David.

By 2018, his PSA reading was

ten; ten or above is considered

high risk, so his doctors used

SmartTarget with HIFU to

locate and destroy the tumour.

His PSA is now stable at around

seven — considered normal for

a healthy man of his age.

David says: ‘I’ve got a caravan

in Wales and I can now drive all

the way there from Halesowen

in the West Midlands without

needing to stop for the loo.’

A

PIoNeeRING two­in­

one scanning system

can detect prostate

cancer as accurately

as experts visually

examining MRI scans,

according to research.
A study in the journal european
Urology compared the new
SmartTarget system with the
standard technique — in which
doctors mentally estimate the
location of the tumour using MRI
(magnetic resonance imaging).
It found that both techniques
separately picked up 80 cases of
cancer that could pose a risk,
according to University College
London Hospital, which tested both
on 129 patients with suspected
prostate cancer.
But each technique also found
13 cancers the other missed —
suggesting a combination, using
both SmartTarget and the doctor’s

visual analysis of the scans, would

give the best results for patients.

If the methods had been combined

in this study, they would have

detected 93 tumours.

experts hailed the results of

the study, in December 2018, as

demonstrating that SmartTarget

effectively pinpoints suspicious

areas, allowing doctors to perform

highly accurate biopsies — and,

if cancer is present, to treat it

more precisely.

Professor Hashim Ahmed, chair of

urology at Imperial College London,

says the accuracy of SmartTarget

allows doctors to identify prostate

cancer more rapidly.

‘This means patients can access

the right treatment early enough,’

he adds. Professor Ahmed

was involved in

the SmartTarget

trial, which was funded

by the Department of

Health and Social Care

and the Wellcome Health

Innovation Challenge Fund.

‘Prostate cancer detection has

been improving at a very fast rate.

This technology pushes the science

even further forward.

‘Its accuracy means it could reduce

the number of biopsies needed and

cut down on unnecessary operations

caused by overdiagnosis of less

harmful cancers.

‘Because it’s relatively easy to use,

SmartTarget could also enable less

experienced centres to catch up

with others on their diagnosis rates.’

This is because staff who don’t

have the necessary skills can be

trained quickly to use SmartTarget,

enabling centres to improve their

prostate cancer detection rates.

Tim Dudderidge, a consultant

Treatment:DavidBeale

A QUICK burst of exercise

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DO THIS...

Pictures: PAUL TONGE / GETTY