Creation of an advanced imaging, targeted biopsy, and genomic composite index to predict prostate cancer progression during active surveillance

Improving risk assessment strategies to personalize care for patients with prostate cancer

Prostate cancer is the third leading cause of cancer-related death among Canadian men. However, not all prostate cancers pose an immediate threat. For men with low-risk prostate cancer, a monitoring regimen known as active surveillance has become the standard of care, allowing them to avoid the potential side effects of surgery or radiation, such as impacts on sexual, urinary, and bowel function. The challenge, however, lies in accurately identifying which patients can safely go on active surveillance without risking the progression of a potentially lethal tumour.

Creating a tool to calculate this risk is the goal of a new project led by Dr. Adam Kinnaird, a surgeon-scientist at the University of Alberta. Funded by the Marathon of Hope Cancer Centres Network’s Clinician-Scientist Award, the project aims to develop a cutting-edge risk calculator that combines information from advanced imaging and biopsy techniques with genetic data to more accurately predict which men are at increased risk of developing aggressive prostate cancer.

"As a Urologist, I see, diagnose, and treat men with prostate cancer every day. Many men on active surveillance are worried about their risk of progression and fear that delaying treatment may affect their life expectancy," explains Dr. Kinnaird. "Conversely, some men are desperate to avoid further diagnostic interventions like prostate biopsy. This project will provide evidence to help men and their clinicians make decisions about how often a repeat biopsy is needed without increasing the risk of missing an aggressive cancer."

To achieve his goals, Dr. Kinnaird and his team of experts in urology, genomics, and imaging will leverage two extensive cohorts of patients. The first cohort includes approximately 200 men who have undergone a novel imaging and biopsy technique known as high-resolution micro-ultrasound-guided prostate biopsy. The second cohort comprises 1,323 men who, in addition to comprehensive clinical follow-up, have provided research blood samples from which their DNA can be extracted. The team has developed a custom DNA test that sequences the small portion of the human genome known to be associated with prostate cancer diagnosis and lethality—an area that has not yet been extensively studied in the context of active surveillance of prostate cancer.

By integrating molecular imaging techniques with germline sequencing, the research team hopes to improve the accuracy of identifying patients who require closer monitoring, while also reducing unnecessary interventions for those at lower risk.  This will help achieve the project’s ultimate goal, which is to improve outcomes and quality of life for patients with prostate cancer by giving them the right treatment at the right time for their unique cancer, which is the promise of precision oncology.

As part of the MOHCCN Clinician-Scientist Award, Dr. Kinnaird will receive $225,000 from the Network over the next three years, which will be matched by the University of Alberta to total $450,000. In addition to funding, the award will help Dr. Kinnaird connect with a Network that promotes collaboration, sample sharing, and mentorship, helping to accelerate his research and his career.

"I feel immensely honoured to have been selected for this award. This award will advance my career as a Surgeon Scientist and help me to complete an important investigator-initiated trial that may help to redefine how we manage men on active surveillance for prostate cancer," he says.

The $225,000 award is for three years and will be matched by the University of Alberta to total $450,000.