News

May 13th 2021 - Press notes

Hospital del Mar leads clinical trial of a new tool for detecting the sentinel lymph node in prostate cancer

The Urology and Nuclear Medicine and Radiology services at the centre are collaborating with the British company Lightpoint Medical to develop new equipment that will improve the detection of the sentinel lymph node in prostate cancer patients. Hospital del Mar is coordinating the international clinical trial to validate its usefulness. Hospitals from Germany, France, the United Kingdom, the Netherlands and Belgium are participating. The centre is a Spanish leader in the use of the prostate sentinel node technique. This involves injecting the tumour with a marker that drains through the lymph ducts and allows the first tumour drainage node to be detected.  Thanks to this technique, the treatment can be personalised and it is possible to identify more precisely whether the nodes are affected.

Hospital del Mar is leading an international clinical trial to evaluate the performance and suitability of new equipment for locating the sentinel lymph node in prostate cancer patients. The new tool is a flexible, miniaturized probe, which should improve the detection of a marker (a radioactive molecule) injected into the patient to locate the first node the tumour drains to. The technology SENSEI^®, has been developed by the UK company Lightpoint Medical with the support of the Hospital del Mar Urology Service.

A moment of an intervention with the new device

The urology surgery team at Hospital del Mar has successfully carried out the first of 54 operations in the clinical trial, in collaboration with the Nuclear Medicine and Radiology Service. Dr. Lluís Fumadó, coordinator of the study, a consultant in the Urology Service and a researcher in the Genitourinary Cancer Research Group at the Hospital del Mar Medical Research Institute (IMIM), explained the advantages of the new probe. "It is a drop-in device, a probe with a cable that is inserted into the patient's abdominal cavity and which can be handled with the usual instruments. The advantage is that it increases the chances of detecting the sentinel lymph node, as it adapts better to the patient's anatomy than current rigid probes, increasing detection sensitivity". And he adds that "This technology promises a significant breakthrough in the treatment of prostate cancer".

Detail of the new device

The system will be tested in five other hospitals in Germany, France, the United Kingdom, the Netherlands and Belgium, using a variety of techniques, from open surgery to laparoscopy and robotics. For the time being, its designers intend to use it for prostate cancer, but they consider that it could be applied to other types of cancer, including lung, colon and rectum cancer, as well as gynaecological tumours. According to Lightpoint Medical's Director of Operations, Claire Woodthorpe, "Hospital del Mar is at the forefront of innovative scientific research into sentinel node biopsy in prostate cancer. We are delighted to be working with Dr. Lluís Fumadó and the wonderful team at the centre. They have already operated on the first patient in the clinical trial and incorporated SENSEI^® into the surgical procedure with ease. We look forward to working with the team even more in the future". The new device will also be used in robotic urology surgery, like those performed at Hospital del Mar using the state-of-the-art Da Vinci Xi surgical robot.

The Sentinel Node Technique

This technique, which is already used in surgery for other tumours (including melanoma and breast cancer, as well as oral cavity, penile and gynaecological tumours), consists of injecting a radioactive molecule or dye into the tumour. This then drains into the lymph nodes, and allows the first node that drains the tumour, the so-called sentinel, to be detected, which is also the most likely to have received tumour cells. This node is extracted and analysed by the Pathological Anatomy Service to determine whether tumour cells are present. If there are, all the nodes are removed (lymphadenectomy) to prevent the cancer spreading to other parts of the body.

The team during the intervention

Dr. Luis Cecchini, head of the Urology Service at Hospital del Mar, states that "Pelvic lymphadenectomy in prostate cancer surgery is indispensable for the good staging of the tumour and can be used to treat cases with single node metastases. The morbidity is not negligible, as this can cause vascular and nerve damage, or lymphoedema (the accumulation of lymphatic fluid in the extremities and/or in the belly, which causes swelling, pain and loss of mobility) of the lower extremities or scrotum. Optimising its use and limiting it to the sentinel lymph node may prevent many of these problems, as well as reducing surgery time."

When the sentinel node is free of tumour cells, lymphadenectomy can be avoided, in specific cases such as melanoma or breast cancer, thus limiting surgical complications, improving the post-operative period and preventing the appearance of lymphoedema. For prostate cancer, studies such as this one and others currently underway are investigating this possibility, in order to achieve less aggressive and more personalised surgery.

Prostate cancer

This is one of the most common types of tumour. In fact, it is the most common in men. It is estimated that one in six men in Catalonia could develop it during their lifetime. In 2018, 4,271 new cases were diagnosed and the incidence is increasing every year due to its association with age. However, according to data from the Oncology Master Plan, in most cases it is a slow-progressing tumour, with a survival rate of 84% at five years.