A new Winship Cancer Institute clinical trial uses advanced molecular imaging to guide post-surgery radiotherapy in men with recurrent or persistent prostate cancer. The study, funded by a $3.4 million R01 grant from the National Institutes of Health, is led by Winship radiation oncologist Ashesh Jani, MD, and Emory nuclear medicine physician David Schuster, MD. Investigators are looking to enroll 140 prostate cancer patients who will be receiving radiation therapy following removal of the prostate.
Prostate cancer is the second leading cause of cancer deaths in men. Failure of prostate cancer treatment is a major health problem in the U.S. Radiotherapy is often used to treat prostate cancer if the disease comes back after surgery.
The Winship initiated-randomized clinical trial looks at 'standard PET imaging' with an amino acid-based radiotracer (FACBC or fluciclovine, which was developed and first employed at Emory) and a newer PET radiotracer (Gallium PSMA). The goal is to evaluate the PET imaging to determine whether either can be used better guide radiotherapy decisions, fields, and doses, and ultimately, to improve patient outcomes.
The project is building on the results of a previous clinical trial at Winship that showed a 40.5% improvement in giving radiation therapy with advanced imaging compared with routine imaging. There was also an 83.6% change in the precise areas that received radiation with the advanced (PET) imaging compared with the standard imaging. Results of the study have been shared nearly 20 times in scientific papers and at oncology meetings.
This trial involves many innovative components including the first use of PSMA PET in Georgia, radiotherapy boost to lesions identified on imaging, and correlation of imaging findings and post-radiotherapy outcomes with tissue biomarkers. The study also continues the Emory tradition of innovation in molecular imaging and therapy, including the first use of PET-CT, the acquisition of the first PET-MR, and the first use of Lu-177 DOTATATE for treatment of neuroendocrine tumors in Georgia. Emory is the only medical facility in Georgia with the capability of producing the neuroendocrine tumor PET radiotracer Gallium DOTATATE for Winship patients. It is this same capability which will be utilized to produce the Gallium PSMA radiotracer.
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