Collaborative research efforts between Canada and Australia have led to a better pathological understanding of aggressive prostate cancers, which could serve as an indicator for the genetic mutation, BRCA2.
The findings are part of a larger study published online this week in Nature Communications, showing that BRCA2- associated prostate tumours are pre-set to be resistant to standard therapies due to abnormalities in genes responsible for regulating cell growth and division.
Dr. Theodorus Van der Kwast, genitourinary pathologist, Laboratory Medicine Program, University Health Network and lead pathologist of the Canadian Prostate Cancer Genome Network (CPC-GENE) study, co-authored the publication and has since helped outline the role of pathology, sharing important characteristics of BRCA2 associated prostate cancer.
“Linking pathological properties of prostate cancer with genetic findings is a necessary step to developing therapies,” says Dr. Van der Kwast. “And the genetic findings of this study will likely affect clinicians’ decisions when patients show possible indicators of BRCA2.”
Intraductal and invasive carcinomas
A key pathologic component of the study is the distinction between intraductal carcinoma and invasive carcinoma, two cancerous cell structures that may be seen in prostate cancer. Because each is not mutually exclusive of each other there has been significant questioning regarding their development.
To investigate the properties of each, pathologists microdissected the prostate samples containing intraductal carcinoma, separating the two carcinoma components from each other and preserving each for individual genetic testing.
Through this, the research team discovered new information about the carcinomas’ development and proved two commonly held hypotheses wrong.
The first, being that the intraductal carcinoma spreads beyond the prostate ducts into surrounding tissue and becomes invasive carcinoma. The other, suggesting the opposite – that the invasive carcinoma pushes its way into the prostate ducts becoming intraductal carcinoma.
“What we found was that both carcinoma components by essence were distinctly different from each other,” say Dr. Van der Kwast. “The study showed that a common precursor cancer cell diverges into both intraductal and invasive carcinoma. This would mean that prostate cancers with intraducal carcinoma are entirely separate entities from those without.”
The role of pathology – step by step
- The first step for Dr. Van der Kwast and fellow pathology staff was finding, diagnosing and grading prostate cancer samples to ensure a high level of cellularity and consistency among all samples used in the study.
- Pathologists then identified which tissue samples have intraductal carcinoma present and ensured they were assigned for microdissection.
- Using laser microdissection equipment, the tissue sample, about the size of a dime, is dissected, allowing the intraductal carcinoma to be separated from the invasive carcinoma. The dissection process is precise down to the micrometer and uses a laser so thin target cells are left undamaged.
- Once the tissue sample has been micro dissected, both the intraductal carcinoma and the invasive carcinoma for each patient is sent to the genetics team for DNA, RNA and epigenetic testing.
How clinical decisions could be affected
Though inherited BRCA2 affects less than 2 per cent of men with prostate cancer, findings from the study may lead to earlier diagnoses, particularly for younger patients due to intraductal carcinoma being a potential indicator of the mutation.
Of the 14 prostate cancer samples from patients with BRCA2, approximately 57 per cent had intraductal carcinoma present, and of the 500 non-BRCA2 cases studied, just 27 per cent had intraductal carcinoma present.
“For pathologists this means that when a younger patient, below the age of 50 has prostate cancer containing intraductal carcinoma, there is reason to believe they could have the inherited BRCA2 mutation and genetic testing may be a consideration,” says Dr. Van der Kwast.
The genetic findings of the study will likely lead to new treatment options for patients with BRCA2 as well.
Co-principal investigator Dr. Robert Bristow, clinician-scientist at Princess Margaret Cancer Centre, University Health Network says, “We now know we need to explore the use of novel therapies to offset the BRCA2-associated aggressiveness earlier on in the treatment of these men and improve survival in an otherwise lethal tumour. This might include different types of chemotherapy or the use of molecular-targeted drugs that specifically target the changes associated with BRCA2 mutation.”
A team effort
The study required the collaboration of researchers from Toronto, Quebec City and Melbourne, Australia to collect the necessary amount of frozen tissue samples needed for the study.
“Due to the characteristics of prostate cancer, it can be very challenging to locate the cancerous area of the prostate in surgical specimens,” says Dr. Van der Kwast. He says because of this, pathology staff reviewed over 1,000 different frozen tissue samples in order to collect the 514 samples used in the study.
“It takes immense collaboration to produce a study of this magnitude,” says Dr. Van der Kwast, “and everybody plays an important role.”
“As a pathologist, this type of investigation provides the opportunity to ask fundamental questions from a pathology perspective that can go on to affect future studies.”
Additionally, he says because the study is part of the CPC-GENE Sequencing Project, the genomic and pathologic data collected from every sample will be made available to fellow researchers from around the world.
This year marked a 10 year milestone for UHN’s Laboratory Medicine Conference, which has consistently brought together some of the best and brightest lab professionals for what is often the last major continuing education opportunity of the calendar year for medical laboratory technicians and technologists.
Hosted on the last weekend of November, the UHN Laboratory Medicine Program (LMP) curates insightful speakers who work in a wide variety of specialties in lab medicine. With presentations spanning from research in heart regeneration to clinical laboratory accreditation, conference delegates were able to hear a little bit of everything at the one day event.
The 10th Annual Laboratory Medicine Conference became LMP’s highest attended conference yet, and raised the bar for future LMP continuing education events – a challenge the program is happy to take on.
Our speakers included:
“Lab Medicine – Now and Beyond”
Presented by: Tom Clancy, Director, Laboratory Operations, LMP; Dr. Vathany Kulasingam, Biochemist; Dean Maxwell, Genetics MLT, and; Dr. Kathryn Tinckam, Medical Director, HLA Laboratory
Our four person opening talk acted as an update on how where lab medicine is currently at and where it is headed. With technologies evolving so quickly the talk highlighted some interesting reminders on how far the profession has come in the 10 years since the first LMP conference, and had experts from administrative laboratory operations, mass spectrometry, molecular genetics, and histocompatibility share their insights in the unique work they do.
Presented by: Dr. Michael Laflamme, Chair, Cardiac Regenerative Medicine, McEwen Centre and Cardiovascular Pathologist, LMP
The keynote presentation, sponsored by the Canadian Society for Medical Laboratory Science, featured Dr. Michael Laflamme, a newer member of UHN who offered delegates a peek into regenerative medicine and his work on repairing damaged heart tissue. Dr. Laflamme shared details on how he transforms pluripotent stem cells into cardiomyoctyes for transplant and his goals of human clinical trials.
“Utility of Point-of-Care Testing for Management of Coagulopathy in Cardiac Surgery”
Presented by: Dr. Keyvan Karkouti, Deputy Anesthesiologist-in-Chief, Toronto General Hospital
Our third presentation was sponsored by Promega Corporation and featured Dr. Keyvan Karkouti, who discussed the importance of point-of-care testing in cardiac surgery, and how it’s leading to blood conservation and effective blood management. His research group has recently developed a blood management algorithm in cardiac surgery that employs point-of-care coagulation assays.
“Welcome Aboard IQMH”
Presented by: Aisha Ismail, Staff Technologist, Institute for Quality Management in Healthcare (IQMH)
Aisha Ismail is a medical laboratory technologist and staff technologist at the Institute for Quality Management in Healthcare. Her presentation shared an overview of IQMH including what it is today, where it came from, and how the institute is elevating confidence in the healthcare system through it’s accreditation processes.
“Molecular Profiling of Hematological Malignancies”
Presented by: Dr. Andre Schuh, Director of Clinical Services, Malignant Hematology, Princess Margaret Cancer Centre
Following a wonderful hot lunch in generously provided by conference sponsor, Abbott, Dr. Andre Schuh brought the focus back to lab medicine and presented some of his research on leukemia and how molecular sequence data can be used to better treat patients and determine the most effective therapies.
Presented by: Dr. Linh Nguyen, Head, Translational Immunotherapy Laboratory, Princess Margaret Cancer Centre
Our sixth presentation came from researcher, Dr. Linh Nguyen who specializes in translational cancer immunotherapy. Her presentation shared some of the basics in this relatively new area of research and how certain cancers can be affected by the body’s immune system.
“The Way to PA”
Presented by: Martin Grealish, Pathologists’ Assistant, LMP
The final presentation of the day came from LMP’s Martin Grealish who talked about his role as a patholigists’ assistant, how the role is evolving and how the profession is introducing new regulations and certifications to practice. He also gave delegates some advice on how they may be able to pursue a career as a pathologists’ assistant and what may be expected from them.
The conference as a whole was an amazing success, and everyone was able to walk away more informed, and better equipped to handle a new year in Laboratory Medicine. Additionally, all attendees received some great LMP branded 10th annual take-homes, including a conference tote, a steel water bottle and a professional portfolio.
Thank you to all of our speakers, delegates and sponsors for making LMP’s 10th Annual Laboratory Medicine Conference possible. We’re incredibly proud to have offered a decade of continuing education and we look forward to continuing the tradition for years to come!
Dr. Danny Ghazarian, LMP Dermatopathologist
Canadian Society for Medical Laboratory Science
Oxford Gene Technology
As we, at UHN’s Laboratory Medicine Program (LMP) wrap up our recent conference, it seems fitting to acknowledge another successful conference which took place just a month earlier and halfway around the world – the Kuwait Cancer Control Centre’s (KCCC) annual Pathology Conference.
Our colleagues in Kuwait, many of which LMP staff have built close relationships with, have continued with their annual conference, an initial product of the UHN/KCCC partnership, and have once again featured LMP medical staff in the three day event.
This year marked the conference’s third anniversary and its third consecutive year collaborating with the University Health Network. LMP Neuropathologist, Dr. Kenneth Aldape was in Kuwait representing UHN at the event, and presented a slide session focusing on various types of brain tumours. Dr. Aldape was just one of the 10 international speakers featured throughout the three day conference, which included experts from Canada, the United States, England, and Germany.
The conference was once again an incredible success, and we at UHN congratulate the KCCC organizing committee for continuing with the annual conference, and thank them for inviting LMP medical staff as participants.
For more information on the KCCC 3rd Annual Pathology Conference visit: http://www.kcccpathology.com/index.htm
Karim Bhaloo, medical laboratory technologist, LMP has once again moved up the ranks at the Ontario Society of Medical Technologists (OSMT) being named the new president at last week’s annual general meeting.
Over the last six years Karim has been actively involved with OSMT, holding multiple positions including, district director, director at large, chair of the editorial committee and most recently vice-president. But now, Karim has a much larger role to play in advocating for the profession and is accountable for the society’s board of directors and is also the primary liaison between the board and executive director, Blanca McArthur.
Karim identified a couple key priorities that he will focus on over his two year term, one of which is to increase OSMT’s presence on social media. He notes that there are a lot of opportunities to engage with stakeholders through channels such as Twitter, and sees it as a good forum to advocate for the profession and connect with related organizations.
Another focus of Karim’s will be engaging medical laboratory technicians/assistant (MLA), and encouraging more involvement with OSMT and MLA regulation.
Karim started as OSMT’s district 5 (greater Toronto region) director roughly six years ago, and he laughs, saying despite his climb up the ranks to president, there is still no limo or security detail (though he doesn’t seem to mind).
It’s an exciting time all round for the OSMT with new appointments on the board of directors, a new president, and as of January 1, 2017 the society will also have a new executive director in Michelle Hoad, former director of marketing and communications at The Canadian Society for Medical Laboratory Science (CSMLS).
For those on the fence about joining organizations like OSMT, Karim would strongly encourage you to go for it. Whether it’s OSMT, CSMLS, the College of Medical Laboratory Technologists of Ontario (CMLTO), or any one of the other organizations tied to the medical laboratory profession, Karim says, “it doesn’t matter if you’re involved for two year or two days, you’ll be able to learn from the experience and grow as a professional.”
About the OSMT
The Ontario Society of Medical Technologists (OSMT) was founded in 1963, and is a member driven, non-profit society advocating for laboratory professionals and acting as a voice for medical laboratory technologists and medical laboratory assistants/technicians in Ontario.
Click HERE for more information.
In case you missed it on UHN News (10.05.2016):
The infamous, “So what do you do?” question can stir an inner conflict in most. Even when the question is specific to profession, medical staff from UHN’s Laboratory Medicine Program (LMP) may struggle to choose a definitive answer.
Between balancing clinical work and research, for LMP staff, the answer may just depend on the day.
In LMP, there are hundreds of different specialized laboratory professionals who practice clinically each day. Many of these same staff also dedicate huge portions of time outside of their clinical work to advance medical research and conduct innovative studies.
This type of juggling between research and clinical practice is one that many in LMP choose to embrace, as their clinical experience can often help steer research towards practical applications.
“‘From bench to bedside’ is a phrase we use a lot in LMP and our staff research is a great example of how we deliver innovation from our labs to our patients,” says Dr. Runjan Chetty, interim medical director, LMP.
“Lab medicine is often considered an essential aspect of any study, and our medical and technical staff routinely contribute to and lead investigative studies, bringing clinical experience to the forefront of medical research.”
In case you missed it on UHN News (10.05.2016):
David, 71, and Kayla, his foster daughter, used to travel 320 kilometres in total to Toronto General Hospital every month for Kayla’s transfusion. Now their time on the road and in clinic has been reduced by half. (Photo: UHN Visual Services)
A program developed by the Toronto General Hospital (TGH) Red Blood Cell Disorders Clinic, UHN Transfusion Medicine, Medical Day Unit and LifeLabs Medical Laboratory Services decreases patient trips to the hospital and cuts wait times for blood transfusions in half.
TGH patients can now have their initial blood drawn at a location near their home or work. These blood samples are then transported to the Blood Transfusion Laboratory at TGH where the sample is used to crossmatch the patient with donor blood in preparation for transfusion.
Having the samples collected and tested before patients come for their transfusions reduces time spent in clinic and the need to come to the hospital twice.
“This program has had a profound effect on our patient experience,” says Kate Uchendu, Nurse Practitioner, UHN Red Blood Cell Disorders Program, who spearheaded the new process with a team from UHN Blood Transfusion Labs, UHN Red Blood Cell Disorders Program, LifeLabs and the Medical Day Unit.
The assessment team from IQMH wrapped up their week long accreditation process on November 18, and LMP staff were left with a lot to be proud of.
The assessment, which spanned across LMP sites and departments went as successfully as anyone had hoped. There was an exceptional amount of positive feedback on the things we do right, and we’ve been made aware of the few things we need to improve on. As was said at the beginning of the accreditation process – external quality assessments are meant to be a good thing, non-conformances and all.
Assessed against over 1900 requirements, LMP labs received a conformance rate of over 99 per cent, which was touted with much praise from the IQMH assessment team. Assessors credited all areas of the labs for the impressive results, and acknowledged a drive and passion in every area they visited.
The IQMH accreditation results reflect our commitment to exemplary patient care and safety. It speaks to the amazing staff across LMP labs, the outstanding Laboratory Information Systems team, and the quality teams present throughout the program. Congratulations to all on the success of the accreditation and the things staff do daily to deliver the best possible patient care.
During the week of November 14-18, LMP and all of its labs will undergo a peer review assessment by the Institute for Quality Management in Healthcare (IQMH).
The assessment is a familiar process for many LMP staff as Ontario labs are required to renew their accreditation every four years, but for newer staff there can be a lot of unknowns. To shine some light on IQMH, the purpose of the assessment and what LMP staff can expect we asked Mary Fountas, LMP Quality and Safety Manager a couple of key questions. So if you’d like to learn more, read the Q&A below!
- What’s the purpose of IQMH accreditation?
Successful IQMH accreditation is all about showing patients, clients, and ourselves that we are meeting our commitment to safe and effective patient care, and continually improving our practices.
- How has LMP scored in past IQMH assessments?
In the past we’ve received very few citations in IQMH assessments. In 2012 we actually had zero majors and zero repeat citations. Though, it’s important to point out that receiving citations isn’t necessarily a bad thing, in fact I think it’s often a reminder that there’s always room to improve how we do things.
- What does it mean to receive citations from IQMH?
You know how in your house you stop seeing things that other people might notice at first glance? A lot of the time citations are just like that. That’s what makes it an important practice. If there’s anything we’re doing incorrectly or anything we can improve on we want to receive that citation, so we can address the issue and make our practice better for everyone.
- As an LMP staff member, what role do I play in the assessment process?
Your primary role is the same as it is on any other day, and you just continue to perform your work as it’s documented to be done. If an assessor from the IQMH team asks you a question, answer them to the best of your ability and try to show evidence in Paradigm or lab documents to support your answer. If you’re unsure what the assessor means or what they are looking for, ask a colleague or manager for assistance.
- What types of things will assessors look for as they tour our labs?
You can expect the IQMH team to look for records or evidence showing that we meet the requirements set in our quality management system. Assessors will also follow along in our work and ‘buddy’ with staff at the bench to see the process we use to conduct a particular test or activity.
- Is there anything we need to do to prepare our lab space?
As someone who specifically focuses on quality and safety, it’s always a good time to tidy up your workspace and check to make sure you know where specific documents and records are kept. If you see anything out of place or of possible concern, notify your manager or supervisor.
- What do we hope to learn from this assessment?
When it comes down it – we want to confirm what we’re doing right, and learn what areas we can improve on.
- Any other thoughts you’d like to share as we get closer to our assessment dates?
I think the most important point to make is that the IQMH team is not here to assess you, but here to assess our facility and how our quality management system supports you in your work. It should be taken as a positive to have this type of peer-review assessment and it ties in with our commitment to Caring Safely and becoming a High Reliability Organization.
Stay tuned for more details on LMP’s upcoming IQMH assessment in the weeks to come!