Researchers in the Netherlands have developed an imaging technology that can accurately identify tumors. The technology is based on ultrasound, and has the potential to evaluate how aggressive tumors are leading to better and more appropriate treatment, and cost savings in healthcare.

About 11% of men who die of cancer in the western world do so because of prostate cancer. Each year 200,000 men are diagnosed with the disease in the United States alone. However, diagnosis is still rudimentary. After determining the prostate-specific antigen (PSA) level in the blood, biopsies are performed to see if there are tumors in the prostate. However, the PSA level is not a very good indicator: two-thirds of all biopsies turn out to have been unnecessary.

The biopsies also have disadvantages; for example, they are not targeted, but instead tissue is sampled randomly using 6 to 12 needles. The chance that the needles will miss a tumor is high, causing a false-negative result. In around one-third of cases with negative biopsies, tumors are later found to be present. Moreover, doctors often operate after a positive biopsy, but find a tumor so small that it would have been better not to operate.

The new technology, developed by researchers from Eindhoven University of Technology (TU/e; Eindhoven, The Netherlands), in cooperation with Amsterdam Academic Medical Center (AMC; The Netherlands), uses the injection of microbubbles of a contrast agent with no side effects. The response of the tiny bubbles to ultrasound is different from that of human tissue or blood. This makes the bubbles traceable from the outside, right into the smallest blood vessels. The pattern of blood vessels in tumors is different from that in healthy tissue. The researchers can recognize this pattern from advanced analysis of the bubble concentrations. Moreover, because tumors need blood--and therefore new blood vessels--to grow, the researchers expect to be able to see how aggressive the cancer is from the pattern of the blood vessels.

The technology has been tested on four patients from whom the affected prostate was removed, according to Dr. Massimo Mischi of the TU/e department of Electrical Engineering. The location and size of the tumors turned out to match accurately with the images produced using the new technology. Dr. Mischi presented these first, promising findings at the annual Radiological Society of North America (RSNA) meeting, held November 28 to December 3, 2010, in Chicago, IL, USA.

In 2011, the investigators plan to carry out a pilot with biopsies guided by images made using the new technology. This allows the biopsies to be targeted, and therefore more effective. In a later phase the ultrasound technology will be used to decide whether biopsies are required, which will reduce the number of biopsies performed. The researchers expect their technology to be available in hospitals within five years. The ultimate goal is for clinicians to be able to determine if an operation is necessary, and if so what kind of operation, based on the images produced, without the need for biopsies.

All in all physicians will ultimately be able to intervene much more accurately, expects Dr. Hessel Wijkstra, head of urology research at AMC Amsterdam. Dr. Wijkstra was appointed part-time professor of hemodynamic contrast sonography at TU/e in November 2010. Moreover, he believes that there will be less unnecessary operations. In some instances, physicians may decide to leave small, nonaggressive tumors untouched and monitor these tumors, in cases where a tumor is not causing any symptoms and is not impairing the health of the patient. In these cases, the health effects of surgery are worse than those of the tumor itself. An additional beneficial effect of this new approach is that the total costs will be reduced.
 

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