URMC Team Gets $2.5 Million to Improve Prostate Cancer Treatment

Researchers To Design, Build Robotic System for Brachytherapy

December 08, 2003

Researchers at the University of Rochester Medical Center are working to end the guesswork associated with brachytherapy for prostate cancer.  They are designing a robotic system to deliver radiation with greater precision in hopes of improving survival and minimizing the side effects with this common treatment.

Funded by a five-year $2.5 million grant from the National Cancer Institute, the team will design and build a robotic system to assist surgeons during this delicate procedure. 

Brachytherapy is a common treatment for early stage prostate cancer that involves the surgical placement of tiny radioactive seeds – about the size of a grain of rice -- into the prostate gland to destroy cancer cells.  The success of brachytherapy hinges on treatment planning and placement of the radioactive seeds at precise locations within the prostate to destroy all nearby cancer cells without harming the healthy tissue surrounding the prostate.

“Current instruments and technology associated with this procedure are very crude,” says Paul Okunieff, M.D., radiation oncology chair at the URMC’s James P. Wilmot Cancer Center.  “The surgeons insert seeds into the prostate and in most cases they are ‘eyeballing it’ and guessing where the seeds should go.”

Currently, it takes a highly skilled team to effectively place the seeds, using past experience and intuition to guide long needles to distribute the seeds into the prostate gland with pinpoint precision.

“It takes significant time and training for surgeons to be skilled at brachytherapy,” says surgeon Edward Messing, M.D., urology chair. “Any advances in technology that can expand and increase the accuracy and precision should improve the outcomes for men with prostate cancer.

The robotic system would offer greater precision for placing seeds and “the opportunity to have dexterity for micromanipulation that could outperform a doctor’s skills,” Okunieff says.  “Just like a machinist with a better lathe can make a better product, if you place the seeds better, the patients should do better.”

Medical physicist Yan Yu, Ph.D., associate professor of radiation oncology, secured the five-year NCI grant and will lead the program to develop a motorized needle manipulation and seed deposition system. 

The team is working with experts from Singapore who have developed robotic technology for prostate biopsies. The robotic system would integrate ultrasound imaging and treatment planning software systems developed at University of Rochester Medical Center to improve radiation dosage.

In the operating room, the system would replicate the surgeon’s motions, sensing the force and rotation needed to place the radioactive seeds.  “We plan to design the system to be able to correct any seed displacements and alter the remaining plan to accommodate for the displacements,” Yu says.

The team will also develop a technique to verify the placements of seeds in the operating room, using ultrasound technology.  Currently, surgeons can’t determine the success of the placements until after the patient gets a CT scan following surgery.  By that time, it’s too late to alter the seed positions.

URMC and Wilmot Cancer Center have a long tradition of prostate cancer treatment innovations. 

In collaboration with RTek Medical Systems LLC, researchers recently developed software for real-time treatment planning for brachytherapy.  The sophisticated system called PIPER (Prostate Implant Planning Engine for Radiotherapy) determines the number and location of seeds to be placed to effectively destroy the tumor.  It’s speed and optimization capabilities are essential during the surgical procedure.

Surgeons were the first in the state to offer laparoscopic radical prostatectomy and recently began using robotic technology to improve the precision of this minimally invasive procedure.  The Medical Center is the first upstate institution to use the daVinci Surgical System to advance laparoscopic procedures.

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Leslie White
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