Indiana University is leading the way in the development of groundbreaking nanotechnology to revolutionize screening for prostate cancer, the second leading cause of cancer death among men in the United States.
A professor of biomedical engineering and informatics at IU Indianapolis, Mangilal Agarwal is working in collaboration with physicians and industry partners to adapt existing technology as well as develop new technology to produce more reliable and accurate prostate cancer screening methods. The work recently received support from a $1.2 million grant from the American Cancer Association.
Although the technology under development is cutting-edge, its inspiration comes from a much older source of knowledge: humanity’s longtime animal companions, dogs.
“The whole project began about nine years ago when I read an article from researchers in Italy who had discovered that canines were able to detect prostate cancer with 98 percent accuracy by smelling urine from patients,” Agarwal said. “As an engineer, I thought, OK, there must be some unique molecules they’re smelling, some specific volatile organic compounds unique to prostate cancer.
“If we could identify those compounds, then we could engineer a technological solution.”
To achieve this goal, Agarwal designed a study to identify several volatile organic compounds that appear to be unique to urine samples from patients with prostate cancer.
Under the new grant, Agarwal’s lab will work to not only confirm they have identified the correct compounds but to translate the results to more portable systems that can be used to non-invasively screen for prostate cancer in point-of-care settings, such as clinics, or even at home.
The research will use urine samples from prostate cancer patients collected in collaboration with physicians such as Dr. Thomas Gardner, a professor of urology and of microbiology and immunology at the IU School of Medicine, who serves patients at the Richard L. Roudebush VA Hospital in Indianapolis.
Mark Woollam, a senior research scientist at the IU School of Science in Indianapolis, alongside IU graduate and undergraduate students, will chemically analyze the samples and optimize the portable systems. The lab also hosts local high school students over the summer to assist in the research.
“Over the next five years, we expect to produce a comprehensive strategy to translate this technology to the consumer market,” said Agarwal, who is also the institute’s founding director.
Either a clinical test based on adapting existing urine analysis technology or an at-home test based upon new lightweight sensor technology would revolutionize the detection and diagnosis of prostate cancer, according to Agarwal. Currently, physicians rely on a blood test, which looks for a biomarker called PSA, or “prostate-specific antigen.” But because several other conditions can also elevate PSA levels — including an enlarged prostate, prostatitis, some over-the-counter medications and even riding a bicycle — these blood tests can produce false positives as much as 70 percent of the time.
The only way physicians can rule out these other causes is by ordering a prostate biopsy, an often painful and uncomfortable procedure in which a needle is inserted into the prostate through the wall of the rectum.
To achieve the ambitious goal of bringing the world’s first non-invasive, home test for prostate cancer test to market, Agarwal has past experience to rely on. He holds a patent on a breathalyzer test to detect low blood sugar in people with diabetes, inspired by diabetes alert dogs. Agarwal worked with the IU Innovation and Commercialization Office to license this technology — which was also developed at the Integrated Nanosystems Development Institute — with a private corporation that aims to produce a version for the consumer market.
Another goal under the new grant is refining the biomarker detection system to identify whether a patient’s prostate cancer is aggressive, requiring immediate treatment, or “indolent,” which can benefit from a “wait and see” approach, he said.
This is especially important in prostate cancer, which can sometimes progress very slowly. Some elderly patients never require surgery since the progression doesn’t outpace a natural lifespan.
The ability to detect indolent forms of the cancer could prevent these patients from undergoing unnecessary therapies, Agarwal said. Prostate cancer treatment requires either surgical removal or chemotherapy, both of which can cause serious side effects or permanent physical damage, including incontinence and erectile dysfunction.
Agarwal is also eager to investigate biomarkers to detect cancer progression, which could potentially improve medical decision-making, reduce overtreatment and decrease morbidity for those at risk or diagnosed with prostate cancer. He is actively seeking support to pursue this other avenue of research, which would track patients whose doctors are monitoring their disease progression, or patients who are currently under treatment.
“Prostate cancer is a disease with a real overtreatment and undertreatment problem,” he said. “There are both too many false positives and not enough people getting screened due to the fear of needing a biopsy. An easy, painless test would both reduce these hardships as well as increase the number of people who are getting screened, reducing deaths from the disease.”
