Prostate Cancer Research and Clinical Trials
City of Hope has long been a leader in prostate cancer research. Our goal is to bring the latest scientific findings into medical practice as quickly as possible. At City of Hope, patients often have access to promising new therapies long before they are available to the general public.
 
City of Hope’s Prostate Program is a collaborative, multidisciplinary prevention, treatment and research program with the goal of providing state-of-the art care for patients with prostate cancer. We lead and participate in numerous national and international clinical trials evaluating new treatments for prostate cancer. Our program conducts clinical, translational and laboratory research striving to improve our understanding of the disease process and to guide the development of new diagnostic, prognostic, and therapeutic interventions. From diagnosis and treatment to recovery, our renowned urologists, medical oncologists, radiation oncologists, surgical oncologists and researchers work in partnership, combining their expertise and skills to deliver exceptional patient care.

To learn more about our clinical trials program and specifically about clinical trials for prostate cancer, click here.
 
Some of the current research studies underway at City of Hope:
 
Clinical Research

Telomerase and Methylation: New Prostate Cancer Detection Tests
This new noninvasive test, which detects the presence in prostate fluid of telomerase, an enzyme associated with certain cancers, may prove to be more sensitive than prostate-specific antigen in the detection of prostate cancer.

This research could lead to the development of improved clinical tools for the early detection of prostate cancer, while substantially reducing the number of unnecessary biopsies. In addition, prognostic markers may also be identified, which could help to identify patients at highest risk for recurrence and who may benefit from additional therapy. The telomerase/methylation test is only available at City of Hope as part of a clinical trial.

Mapping Interactive Cancer Susceptibility Genes in Prostate Cancer
Cancer researchers have recently identified several biological factors that may be important in the development of prostate cancer. This study seeks to determine the role of more than two-dozen genetic factors in cancer research and specifically whether there is any relationship between any of these genetic factors and the risk of developing prostate cancer. We are studying whether genes with weak contributions to cancer risk can interact to produce a strong risk.

Erectile Dysfunction Study
A clinical study is currently under way to evaluate whether patients who use regular, low doses of erectile function drugs soon after surgery return to potency faster than those who do not take the doses regularly. This study will help determine if it is beneficial to start rehabilitation as early as possible to increase blood and oxygen flow to the penis. City of Hope researchers are looking to recruit 220 men for the study. Study-related medications will be provided to participants free of charge.

Quality of Life and Psychological Adjustment in Prostate Cancer Patients and Their Partners
This study examines the psychological adjustment and quality of life (QOL) issues that may affect prostatectomy patients and their partners. The primary focus is on understanding the role of social factors on partner psychological functioning, the impact of pre-surgical expectations on patient QOL outcomes one year later, and the trajectory of prostate-cancer specific QOL over time. This data will enhance our understanding of the impact of cancer on patients and family members, shed light on patient-partner interactions that may inhibit adjustment following diagnosis, and inform the development of psychological interventions aimed at improving psychosocial adjustment and QOL in prostate cancer survivors and their partners.

Prostate Cancer Outcomes Database

City of Hope has established a prostate cancer database to collect data on all consenting prostate-cancer patients receiving their primary treatment at City of Hope. The data is used to analyze clinical outcomes and quality of life, correlate with ongoing fundamental science research studies, and establish standards for newly developed treatment modalities, including laparoscopic radical prostatectomy and robotic-assisted laparoscopic prostatectomy.

City of Hope has one of the largest prostate cancer populations in the country. To date, approximately 4,500 minimally invasive laparoscopic radical prostatectomies, including about 4,000 robot-assisted laparoscopic radical prostatectomies, have been performed at City of Hope. Out of these, more than 2,900 minimally invasive laparoscopic radical prostatectomies are included in the database, including more than 2,800 that were performed with robotic assistance.The outcome information obtained from these patients is an invaluable resource for studying how this state-of-the-art technique benefits the patient’s overall quality of life following prostate cancer treatment. To see an example of how this research translates into knowledge for advancing the field, read a summary of “Perioperative complications of laparoscopic versus robotic assisted laparoscopic radical prostatectomy: the City of Hope experience.” Journal of Urology, 175: 541-546, 2006.

Exploring Research Potential of our Tissue Bank
Because of the volume of patients seen, City of Hope has created an enormous tissue bank comprised of samples gathered from more than 1,500 men treated for prostate cancer. This tissue bank is an invaluable resource, because it allows us to study the genetic and molecular characteristics of tumor samples as well as the demographic characteristics of the men being treated and their treatment outcomes. Through this research, we will improve our ability to predict which cancers are aggressive and to tailor treatment accordingly.

Follow-up Clinic for Survivors
The Department of Population Sciences and Center for Cancer Survivorship has collaborated with the Division of Urology and Urologic Oncology to form a long-term follow-up clinic for prostate cancer survivors. The overall goal is to provide specialized care for cancer survivors and, in the process, develop a critical resource of research in cancer survivorship. Care is provided as a consultative service in collaboration with the patient’s primary care provider in order to ensure that the unique medical needs of cancer survivors are addressed. All patients will be offered the opportunity to participate in ongoing research studies through the Center for Cancer Survivorship.

Currently, the Survivorship Clinic provides comprehensive long-term follow-up services for childhood cancer and prostate cancer survivors, with plans to expand care to breast cancer and hematopoietic cell transplant survivors.  Specialized services such as support groups, vocational counseling, and physical/occupational therapy are provided to help survivors successfully return to their lives after cancer treatment. Each survivor seen at City of Hope receives personalized health information based on their diagnosis, treatment and current medical condition, empowering them to take steps to optimize their health. Other educational initiatives planned include a patient resource library, educational seminars for survivors and educational outreach programs for the community.

Translational Research

Translational research brings promising ideas from the lab into the clinical setting. Researchers and clinicians at City of Hope are engaged in ongoing communication and interaction to bring work from the lab to the bedside.
 
Developing More Sensitive Prostate Cancer Tests
Quantitative polymerase chain reaction (qPCR) is a technology used to quantify DNA sequences. This technique is useful in determining the presence and amount of a single, specific sequence within a sample of DNA. Our researchers are using qPCR to study biomarkers linked to chromosome damage in cells, RNA copies made from DNA and changes in DNA methylation patterning. We hope to use these biomarkers to predict the presence of certain indicators of poor prognosis such as the growth of cancer outside the prostate gland, known as extracapsular extension. Preliminary results show that the data gathered through the qPCR, coupled with the Gleason score and PSA test, can predict the absence of extracapsular extension very accurately. Tests of this type may be very useful in determining which patients have forms of prostate cancer that are less likely to spread. These men can then receive less-aggressive treatment

Pre-metastatic Niche Study
For more than a century, it has been posited that the “soil” (or environment) that surrounds a tumor is critical for its development. In fact, the “soil” may be as important as the “seed” (the cancer cell) itself. In the setting of prostate cancer, the pre-metastatic niche may be represent the “soil” -- specifically, an environment that tumor cells from the prostate move toward. The potential impact of the pre-metastatic niche is two-fold. First, while PSA, Gleason grade and stage can offer important prognostic information, none are perfect in predicting clinical outcome. The pre-metastatic niche may be a way in which prognostic information can be offered to reflect the individual biology of the disease. Second, aside from improving prognostic capabilities, the pre-metastatic niche may also serve as a therapeutic target. We are interested in developing our understanding of the pre-metastatic niche in prostate cancer in order to accomplish these aims.

Predicting the Likelihood of Prostate Cancer Recurrence
The Department of Population Sciences is studying a gene known as Fragile Histidine Triad (FHIT), which is a tumor suppressor involved with a variety of cancers. Through collaborations with researchers at the National Cancer Institute and the American Cancer Society, we have identified several regions within FHIT affecting prostate risk. Variations in FHIT introns are associated with more aggressive forms of cancer. City of Hope researchers are investigating their association to tumor aggressiveness and cancer-specific mortality, as well as identifying genetic variations in the FHIT genetic sequences that predict protein expression level in prostate tumor tissue. This research holds promise for a non-invasive test to predict which prostate tumors are likely to spread, necessitating more aggressive treatment, and a potential target for future therapeutic intervention.

Basic Science Research

Scientists from a wide variety of disciplines at City of Hope are involved in pioneering basic prostate cancer research. Sometimes called investigational or laboratory research, this work is focused on making advances that will ultimately improve on our ability to treat patients with prostate cancer. This research may one day be translated into promising treatment for patients.

Using Nanotechnology to Predict Cancer Recurrence
City of Hope’s patented bionanotechnology uses engineered DNA and protein to build tiny programmable machines (smaller than one-thousandth the width of a human hair) called nanoparticles. City of Hope is pursuing a study using these nanoparticles as a means of detecting prostate cancer. There is evidence that the nanoparticles can be used to differentiate between aggressive cancer cells that are likely to come back after treatment and those that are less likely to recur.

Based on lab results, it appears that the amount of fluorescence may indicate how aggressive the cancer is and whether or not the cancer is likely to return. However, when the nanoparticles were tested using slices of tissue obtained from men after prostate cancer surgery, the results were surprising. The fluorescent glow was most pronounced in the regions near the tumor, but not within it. These tumor-bordering regions are known to be areas in which cells in the prostate are reacting to the presence of the tumor as the body loses its fight against the cancer.

The observations may be useful in detecting prostate cancer in non-invasively obtained prostate specimens like those used in previous studies on diagnosis and screening because they identify a new and previously unknown set of prostate cancer biomarkers. One of these (Thioredoxin Reductase I) is being readied for clinical testing in non–invasive specimens.

Evaluation of Anti-prostate Cancer Activity of Mushrooms
The Department of Medical Oncology and Therapeutics Research offers standard chemotherapies as well as access to newly developed drugs through an extensive program of clinical trials. In this study, our researchers have found that mushrooms contain chemicals that act as inhibitors of steroid 5-alpha reductase.  An elevation of the steroid 5-alpha reductase activity in the prostate may cause benign prostate hyperplasia (a common problem in older men) and also promote the growth of prostate cancer. Inhibitors of steroid 5-alpha reductase have been developed to treat these prostate diseases.

The Department of Medical Oncology launched a Phase Ib Trial of Mushroom Powder in Biochemically Recurrent, Hormone Naive Prostate Cancer in collaboration with the Department of Cancer Biology. Optimal treatment options in biochemically recurrent prostate cancer remain presently undefined and new therapies with minimal toxicities need to be evaluated for this population. An ideal therapy would be provided on an outpatient basis and orally administered and would have minimal systemic toxicity, allowing long-term repeated administration. The mushroom powder being tested in this study has the potential to serve in that capacity.
 
Molecular Association between Prostate Cancer and Obesity
We are currently examining molecular biological and genetic approaches to address how obesity interacts with the development and progression of prostate cancer. In addition, emphasis is placed on prostate cancer cell-adipocyte interaction, signaling transduction and gene regulation by adipose cytokines in androgen-independent prostate cancer cell growth.

Immunotherapy
Visit the Department of Cancer Immunotherapeutics & Tumor Immunology to learn more.

Energy Balance and Functions of Homeobox Genes in Carcinogenesis
Visit the Department of Molecular and Cellular Biology to learn more.
 
Next generation hormone therapies 
Hormone therapy is a cornerstone of the treatment of prostate cancer. However, these drugs only work for a limited time span. Investigators at City of Hope have clinical trials underway that explore the next generation of hormone therapies -- drugs that are more potent and that may more completely suppress prostate cancer growth.  In addition, our laboratories on campus are actively developing new compounds that offer a similar and even more potent mechanism.
 
Vaccine therapies (Provenge) 
There are now approved vaccine therapies for prostate cancer that has spread outside of the prostate.  These are not conventional vaccines; rather, they are generated by taking a patient’s white blood cells, stimulating them in the presence of various proteins, and then injecting these cells into the body.  These cells are now primed to mount an immune response against the cancer.  Investigators at City of Hope have developed a trial to determine if radiation therapy may augment the activity of these vaccines.
 
Imaging prostate cancer
The treatment of prostate cancer depends very heavily on the degree to which it has spread.  If prostate cancer is localized, treatments like radiation or surgery might be relevant.  However, if prostate cancer has moved elsewhere (typically, to the bones or lymph nodes), drug therapy may be more appropriate.  At City of Hope, we are developing a protocol to incorporate new modes of imaging.  Specifically, we are using a scan technique called Sodium-fluoride PET to determine more precisely if prostate cancer has gone to the bones.  We are also introducing the use of a whole body MRI that will better capture the spread of prostate cancer to many structures.  With these techniques, we hope to optimize the appropriate management of patients.
 
Treatment before surgery (Axitinib)
Investigators at City of Hope have discovered an association between a certain molecule, called VEGFR1, and recurrence of prostate cancer after surgery.  There is an FDA-approved drug that targets VEGFR1, and investigators have created a protocol that treats patients with this drug prior to surgery for prostate cancer.  Using this strategy, we hope to limit the situations in which prostate cancer recurs after surgical intervention.
 
Diagnostic Trials

City of Hope has been an innovator in diagnostic research to more precisely track the progression of prostate cancer. Using new biomarkers recently discovered at City of Hope, our research team is addressing some of the most pressing problems in the diagnosis of prostate cancer. Their research is making it possible to predict the outcome of a prostate cancer biopsy with a high degree of accuracy.
 
The new test addresses one of the vexing problems in diagnosing prostate cancer and may help many people avoid the unpleasant biopsy procedure. Our investigators’ research is also helping to detect prostate cancer that has grown outside the prostate gland itself among patients that are thought to have low-risk prostate cancers.  These new biomarkers will also help our physicians counsel patients who are considering active surveillance.
 
Using Expressed Prostatic Secretions (EPS) to Rule Out Prostate Cancer

Clinicians and scientists are working together to develop a more accurate and easily-administered test. This screening test evaluates expressed prostatic secretion (EPS), a fluid that can be collected from the prostate, for various genetic markers that indicate the presence of cancerous cells. It will help determine whether EPS can be used to rule out cancer in patients being evaluated for prostate cancer in the urology clinic. These studies use the methods of molecular biology to identify whether cancer cells are present in EPS, which can be obtained non-invasively. The goal is to develop a new non-invasive tool for determining whether patients should proceed with further invasive testing like prostate biopsy.

Preliminary studies have demonstrated that when used in tandem with the PSA and a digital rectal exam, the EPS screening has a positive predictive value that approaches 85 percent.  In addition, the test may help to predict the aggressiveness of the cancer. This is significant because if more-aggressive cancers can be identified early, men who are at greater risk for dying from prostate cancer or developing metastatic cancer can receive beneficial effects of treatment.
 
Taken together, these assays are proving to be valuable in determining if a biopsy is necessary.
 
Interoperative Optical Imaging (IOOI)
Likened to “seeing the invisible,” Interoperative Optical Imaging (IOOI) offers a way to paint a tumor to reveal exactly where the cancer is located in order to remove all the malignant cells while sparing normal tissue. The technique should help prevent subsequent treatments that are sometimes necessary when the surgeon could not initially detect all of the cancer. IOOI combines the precision of robotic surgery with fluorescent microscopy to illuminate cancerous cells “real time,” enabling surgeons to excise cancer more precisely. Clinical trials using patients begin in Fall 2013.