A dye that sticks to prostate cancer cells could help surgeons “strip them all away” while protecting healthy tissue, according to a team of our researchers at Oxford University.
In an early study of prostate cancer surgery in 23 men, the fluorescent dye lit up areas of cancerous tissue that surgeons couldn’t see any other way. In future, it could also be used for other types of cancer.
“We are giving the surgeon a second pair of eyes to see where the cancer cells are and if they have spread,” said Professor Freddie Hamdy, lead author of the study. “It’s the first time we’ve managed to see such fine details of prostate cancer in real-time during surgery.”
Surgeons can cure early-stage prostate cancers by cutting out all of the cancerous cells, but it’s almost impossible for them to see any that might have spread into areas surrounding the main tumour. The dye, which is linked to a special targeting molecule, attaches to proteins on these cells and spotlights them for the surgery team.
“With this technique, we can strip all the cancer away, including the cells that have spread from the tumour and could give it the chance to come back later,” said Hamdy, who is also Nuffield Professor of Surgery at the University of Oxford. “It also allows us to preserve as much of the healthy structures around the prostate as we can, to reduce unnecessary life-changing side-effects like incontinence and erectile dysfunction.”
David’s story
David Butler, 77, a retired sales development manager from Southmoor in Oxfordshire, was one of the 23 men who took part in the ProMOTE study. A chance conversation with his GP turned into a shock diagnosis of prostate cancer in November 2018.
“I had literally no symptoms apart from needing to pee more quickly whenever I did go to the toilet,” David said. “Had I not told my GP about it, I might not have caught my cancer until it was much further down the line.
“Very strangely, I was relaxed about the diagnosis. I had a sense that the consultant was going to tell me it was bad news – so I wanted to be positive and face up to it. I think the staff thought I was taking it extremely well!
“I had several biopsies and scans but one scan – the Prostate-Specific Membrane Antigen (PSMA) PET scan – revealed that the cancer was starting to spread from the prostate. It was in the lymph nodes. It was in loads of places near to the prostate. That information proved vital to the doctors to get the cancer treated quickly.”
The new dye and targeting molecule combination also attaches to PSMA. Surgeons used it to guide David’s radical prostatectomy, which also removed several lymph nodes and other cancerous tissues, in January 2019.
David’s road to recovery was rocky, as he suffered a stroke shortly after the surgery, due to an unrelated heart condition. Five years on, he is fully recovered and has no signs of cancer.
“If you’re not positive, life will come up and bite you, so you’ve got to enjoy every moment. I’ve been told I don’t look my age which is a great compliment!
“I am a very lucky man to have had the life I’ve had. I’ve dealt with a lot health-wise but I’ve had excellent treatment too.
“I retired early to make the most of life’s pleasures – gardening, playing bowls and walking. Taking part in the ProMOTE study has allowed me to have many more of those pleasures for years to come.”
Doing “everything possible” during prostate cancer surgery
The dye and targeting molecule combination (called IR800‑IAB2M) was developed by Oxford scientists in collaboration with ImaginAb Inc., a company based in Inglewood, California. So far, they have focused on PSMA, but, in future, the team could swap in different targeting molecules to help surgeons operating on different types of cancer.
The special imaging system surgeons use to see the dye was also developed in Oxford, by an engineering team led by Professor Borivoj Vojnovic.
Together, the targeted dye and imaging system can show surgeons the edges of the main tumour and identify any clusters of cancer cells that have spread into nearby pelvic tissues and lymph nodes. The evidence so far suggests it could give surgeons a much clearer real-time understanding of what they need to remove and what they should leave untouched than any existing method.
“We want patients to leave the operating theatre knowing that we have done everything possible to eradicate their cancer and give them the best quality of life afterwards,” said Hamdy. “I believe this technique makes that possibility a reality.”
Further clinical trials are already underway in larger groups of patients to find out if the technique helps surgeons remove more prostate cancer cells and preserve more healthy pelvic tissue than existing surgical methods.
The research was funded by Cancer Research UK and supported by Oxford’s Nuffield Department of Surgical Sciences, Department of Oncology and NIHR Biomedical Research Centre.
Hamdy, F.C., Lamb, A.D., Tullis, I.D.C. et al. First-in-man study of the PSMA Minibody IR800-IAB2M for molecularly targeted intraoperative fluorescence guidance during radical prostatectomy. Eur J Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s00259-024-06713-x
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