Prostate research

Imaging

Imaging

We develop and implement novel molecular imaging strategies aiming at precision diagnosis and allow personalized treatment advice in prostate cancer. These techniques include:

• Multiparametric (mp) MRI to localize prostate cancer, determine its agression and extent;
• USPIO-enhanced MR imaging to aid in the detection of nodal metastases;
• Ga-68-PSMA and F-18-PSMA PET/CT to diagnose local recurrence, nodal and osseous metastases.

Our Prostate MRI Center of Excellence is an official expertise center for widespread clinical implementation of mpMRI. It provides education to radiologists and performs second-reads of mpMRI for participating institutions. Clinical research consists of developing new and quantitative imaging biomarkers of disease on clinical 1.5 and 3 Tesla MR scanners and on an experimental 7 Tesla whole body MR system.

In addition, at our Preclinical Imaging Center (PRIME) for multimodality imaging of small animals, new theranostic agents are developed and tested. With scientists covering the research fields from molecule to man to population, we are able to translate new findings from their discovery all the way to clinical application.

Interesting links

Technology Center Imaging
Preclinical Imaging Center
Prostate MRI Reference Center

Image guided interventions

Image guided interventions

Our Medical Innovation and Technology expert Center (MITeC) harbors three interconnected operating theaters which are equipped with state-of-the-art scanners for image guided interventions. Here we perform MRI guided prostate biopsies using an MRI compatible robot to position the needle, which improves the success rate of the biopsies. MITeC also enables the use intra operative CT / MRI imaging to guide the surgeon and improve the outcome of interventions like cryo, laser, RF and high intensity focused ultrasound ablation of tumors. MITeC is unique in Europe, as it combines technological developments and determination of clinical relevance by evidence-based surgery.

Interesting links

MITeC

Image analysis

Image analysis

We provide software tools to read and annotate mpMRI lesions of the prostate for diagnostic centers all over the world, and use artificial intelligence on big patient data to improve and automate the analysis of our imaging and clinical data. This results in the most accurate diagnosis for the individual patient with prostate cancer.

Radionuclide Therapy

Radionuclide Therapy

We have performed clinical studies using Lu-177-PSMA as a therapeutic agent in different stages of prostate cancer: hormone sensitive oligometastatic and metastatic castration resistant disease. We perform extensive dosimetry in our clinical studies, to calculate patient individual doses of the therapeutic agent. We aim at routine DNA sequencing for every patient and finding biomarkers that can predict therapy response.

In addition to Lu-177-PSMA radionuclide therapy, we are developing alpha emitter and photodynamic therapy based on PSMA. We also offer Radium-223 therapy.

MR-linac

By the end of 2020, MRI-guided (MR-linac) radiotherapy will be available at the department of Radiation Oncology. An MR-linac integrates a linear accelerator and a diagnostic quality MRI-scanner to deliver high-precision radiotherapy by adapting the radiotherapy plan to the changes in anatomy during treatment. This ensures an optimal balance between irradiating the tumor and sparing the surrounding healthy tissues. Online adaptive MR-guided radiotherapy allows for: an increase in dose to the tumor, a reduction of toxicity, a reduction of the number of fractions (1-5x) and treatment of new clinical indications. The department of Radiation Oncology collaborates with the Diagnostic Image Analysis Group, the department of Medical Imaging and the Radiotherapy and OncoImmunology Lab to further improve the MR-guided radiotherapy treatments and its outcome. The Radboudumc also participates in a large international research consortium (The MR-linac Consortium) and regional collaboration (Zuid-Oost Nederland) to work together on evidence based introduction of this new technology.

Immunotherapy: Dendritic cell vaccination

Immunotherapy: Dendritic cell vaccination

We investigate the role of dendritic cells in the defense against various forms of cancer including prostate cancer, and we study the effectiveness of dendritic cell therapy. Dendritic cells play an important role in immune responses. In response to infection or inflammation, and in response to cancer, dendritic cells undergo a complicated maturation process, after which they ultimately present fragments (proteins) from the pathogens or cancer cells to T cells in the lymph nodes. These are the ‘killer cells’ of the immune system. Due to the priming from the dendritic cells, they are able to recognize and attack cancer cells.

From these dendritic cells, we developed a vaccine against cancer. For this purpose, dendritic cells are removed from the patient and taken to the laboratory where they are primed with tumor proteins. These cells are then returned to the patient, causing the T cells to attack the targeted tumor cells. The major benefit of this therapy is that it attacks tumor cells throughout the body with very few side effects, partly because the T cells are natural to the patient’s body.

Immunotherapy: T-cell modulation

Immunotherapy: T-cell modulation

Recent years have seen some breakthrough achievements in immunotherapy of cancer by using antibodies to modulate the bodies’ immune system. By blocking the ‘brakes’ on T cells, the soldiers of our immune system and their natural ability to kill tumor cells, is regained. Now these therapies are approved for use in other cancers, their potential has yet to be proven in urological tumors. The department of Medical Oncology is working together with pharmaceutical companies to compare dosing regimens and novel antibody variants, to come to treatments which are effective and show an acceptable profile of side-effects.

Dosing of medication

Dosing of medication

Tyrosine kinase inhibitors are new drugs that fight cancer very specifically. Already 15 types of these inhibitors exist, targeting different types of cancer, including prostate cancer. These inhibitors suppress tumor growth, but the patient needs to take this type of medication daily. This can only be sustained if there are no severe side effects. After all, nobody wants to be in pain or sick for the rest of their lives. This is the reason why it is important to investigate the appropriate dosing of this new type of medication.

At the department of Pharmacy, we are developing a customized treatment for tyrosine kinase inhibitors. In the current standard treatment protocols, all patients receive the same dose. However, it is unknown if this is the optimal dose – with the least side effects – for every patient. By measuring the concentration of the active ingredient of the medication in the blood, the dosing can be adjusted according to the findings and the patient receives a customized treatment. Radboudumc is developing a compex measuring method for this personalized approach.

Digital histopathology

Digital histopathology

The Computational Pathology Group develops, validates and deploys novel medical image analysis methods based on deep learning technology and focusing on computer-aided diagnosis. Application areas include diagnostics and prognostics of breast, prostate and colon cancer. We have a strong translational focus, facilitated by our close collaboration with clinicians and industry.

Interesting links

Computational Pathology Group

Biobank Urological Tumors

Biobank Urological Tumors

In the Biobank for Urological Tumors tissue, blood, and urine from patients is collected and stored ('biobanked") over the course of their disease. Research performed with this material uses innovative genetic screening methods, advanced visualization of the tumor-tissue and immune system, and complementing functional models (e.g. in vitro organoid culture). The department of Medical Oncology and the Laboratory of Experimental Urology work together to group large numbers of patients based on their tumor profile, and to link these to data on treatment outcome. This allows them to improve diagnosis accuracy and to predict the optimal treatment for each individual patient, which will greatly improve clinical outcome.