2014 PCRP Investigator Vignette

Title: Smart Needling Technology and Predicting Risk of Metastases

Investigator: Adam Dicker, MD, PhD; Thomas Jefferson University

So, the first introduction to the DoD Prostate Cancer Research Program was through the funding of a synergy grant with myself and a number of physicists, where we developed smart needles.

So there are a number of therapies for the treatment of prostate cancer where you're inserting needles into the prostate. A common example might be brachytherapy, where needles are put into the prostate and then radioactive seeds are then inserted through these needles, or you're trying to biopsy a particular part of the prostate. So one of the limitations with current needles is they don't discriminate between tumor and normal tissue and there's no ability to really steer the needle.

So a smart needle can sense the tissue, can sense the difference between normal prostate and tumor, and most needles are straight, that's a good thing, but these needles are actually smart and you can have them bend around and curve, and then become straight. So they have the ability, with special properties to sense where they are, as well as be able to direct themselves to particular places where you might want to deliver some sort of therapy.

We've developed the needles. We validated them. We've shown that they can discriminate between normal tissue and prostate using prostatectomy specimens, and we now have a Phase I clinical trial that's been approved by the Food and Drug Administration to now enroll patients and have them treated with this device.

And that's been a very productive collaboration with Dr. Yan Yu, a physicist at Thomas Jefferson University, and a number of institutions, and we're very grateful to the DoD for supporting that work.

Another grant is a postdoctoral award to Dr. Kosj Yamoah. I'm a mentor to Dr. Yamoah, as is Dr. Tim Rebbeck at the University of Pennsylvania.

Kosj is from Ghana, and what he's particularly interested in is, can he use the new molecular tests that are now being developed to help prostate cancer patients.

The grant is in a collaboration with a company called Genome DX that's based in Vancouver and San Diego. And they developed the Decipher signature. This signature was developed from the Mayo Clinic from about 10,000 prostatectomy specimens.

So this signature identifies which patients are going to develop a metastasis, and they can predict it with a higher level of certainty than the known clinical parameters that we currently use when taking care of patients.

Now, in the Mayo Clinic in Rochester, Minnesota, they had a mostly Caucasian population. So we don't know if this metastases signature applies to African American patients or African patients.

Kosj Yamoah is a trainee in radiation oncology, and he has a unique access to samples, tumor samples, prostate biopsies from African American patients in the Philadelphia region, as well as from African patients in Ghana, Senegal, and other neighboring African countries.

And he's going to see if he can develop a specific molecular test for these African-either African American or African-African-patients and see if this can add value because it's thought that the African American patients, particularly in the United States, either present with more-advanced disease or are thought to have a more aggressive type of prostate cancer. And the molecular test will help personalize therapy so you don't overtreat someone if their disease is not as aggressive, and you don't undertreat someone who may require a more comprehensive, aggressive approach to their care.

For us and other people in the field, we're looking to have the greatest therapeutic ratio, meaning, how can you help the most and hurt the least. No one enjoys having a needle put into them, but if you can do it in a less invasive way and reduce the risk of injury, you know that has significant clinical benefit. If you have a molecular test that can determine whether a patient should be getting a more aggressive therapy or a less aggressive therapy, it has a huge impact on their quality of life. And I think, in a short time, meaning, in just a few years, for both the molecular tests, the genomic tests that we're involved with, as well as some of this smart-needle technology, we'll be able to show direct clinical benefit to patients.