High-tech treatment options for prostate cancer patients

Oct 1 2013

Associate Professor Jarad Martin

Associate Professor Jarad Martin with a radiotherapy unit at Calvery Mater Newcastle

Radiation oncologist Associate Professor Jarad Martin, a member of HMRI’s Cancer Research Alliance, is using advanced MRI scanning to accurately track men’s bone composition as they undergo hormone therapy in conjunction with radiation treatment.

“I’m trying to work out why some men’s bones stay strong as they go through the hormone therapy whereas other men’s bones almost dissolve,” Associate Professor Martin said. “It’s not really clear who those patients are, so by doing MRI of the spine I’m hoping we will develop a predictive model on the high risk patients.

“We can hone in on the guys who will really get the benefits.”

Under the RADAR (Randomised Androgen Deprivation and Radiotherapy) trial being run by Associate Professor Martin’s colleague, Professor Jim Denham, patients also receive the drug Zometa to prevent losses in bone mineral density and stop the spread of metastatic cancers into the bones.

For the research team based at Calvary Mater Newcastle it’s all about giving men alternatives to having the prostate surgically removed.

The radiotherapy department is one of the most productive in Australia when it comes to international research publications, their broad portfolio ranging from supportive care to technical studies involving MRI integration, radiotherapy planning, tracking of the prostate and duration of hormone therapy.

“For some guys having the prostate removed is absolutely the right thing to do because they get that psychological peace of mind,” Associate Professor Martin said. “But the operation can knock their ability to have erections, and varying degrees of bladder leakage is also common.”

Associate Professor Martin is particularly interested in quality assurance when delivering radiotherapy.

“There have been studies showing that if you give poor radiotherapy the outcomes are a lot worse. You might have the world’s best drug but it’s overwhelmed by poor radiotherapy,” he said. “We obsess over fractions of a millimetre because the bladder and rectum are right next to the prostate.”

A radical new form of treatment is known as brachytherapy where a fragment of Iridium 192 – the radioactive material widely believed to have caused the extinction of dinosaurs – is placed directly into the prostate to kill the tumour from inside out.

Associate Professor Martin and his team are now looking at doing the same thing non-invasively with stereotactic radiotherapy, using high doses of radiation but employing innovative measures to keep the prostate still and track it.

With the prostate moving according to how full or empty the bladder and bowel are, they use a gold grain implanted in the prostate as a target for directing the radiation beam.

“We don’t get instant results. Radiation kills cancer only when the cancer tries to grow, and prostate cancer often grows slowly, so it fades away slowly with the radiation.

“You watch for two to three years as the PSA glides down to a safe level. It’s a different concept to surgery – it’s a long-term investment.”

* HMRI is a partnership between the University of Newcastle, Hunter New England Health and the community.