Alberta Cancer Foundation

Research Rockstar: Dr. Lindsay Rowe

Dr. Lindsay Rowe researches how a new, cutting-edge imaging technique can lead to improved, more precise prostate cancer treatment 

By: Keri Sweetman

Dr. Lindsay Rowe conducts her PSMA-PET scan research out of the Cross Cancer Institute. Photograph by Ryan Parker.

Dr. Lindsay Rowe doesn’t have to look far to find the motivation she needs to drive her cancer research forward.

“It sounds cliché because I’m sure every doctor says this, but it’s my patients who motivate me,” says Rowe, a radiation oncologist and clinical researcher at the University of Alberta (U of A) and the Cross Cancer Institute (the Cross). “I can walk into a room with a very academic mentality. And then I sit in front of the patient and their family, and my heart just melts. [I want to] find a solution.”

Her role as a radiation oncologist is to use high-energy radiation beams to kill cancer cells, which can go places in the body that are not operable. In her clinical practice, Rowe sees patients with genitourinary cancers (prostate, kidney, bladder and testicular) and brain tumours.

Since joining the U of A in 2019, her research has focused primarily on prostate cancer, the most-diagnosed cancer in Canadian men. The standard diagnostic tool is a simple blood test, which looks for higher levels of prostate-specific antigen (PSA) that could indicate prostate cancer. While this cancer is usually highly treatable, with a five-year survival rate of 95 per cent, the cancer can spread to the lymph nodes (in 15 per cent of high-risk prostate patients) or metastasize to another location in the body (which occurs in another 10 per cent of high-risk patients). Imaging, such as CT scans and MRIs, is used to follow patients’ cancer trajectories, but these technologies aren’t always successful in finding if and where the cancer has spread. 

Rowe’s research interest is a new, cutting-edge imaging technique called PSMA-PET. PSMA, or prostate-specific membrane antigen, is a protein found on prostate cancer cells. PET scans (positron emission tomography) use radioactive tracers injected into the body to allow doctors to look for cancer cells. Once the PSMA-binding tracers are injected into the body through a vein, they look for the receptors on the prostate cancer cells and bind to them, showing up on the PSMA-PET scan as bright lights.

This technology gives physicians a much clearer view than they would get with a CT scan or MRI alone, allowing doctors to determine the stage of the disease more accurately, as well as the location of cancer cells in the prostate, the nearby lymph nodes or elsewhere in the body. With this information, radiation oncologists can tailor their treatment with appropriate levels of radiation therapy in precise locations. 

Rowe hopes her research will lead to a PSMA-PET program in Alberta, with wider availability of the scans. PSMA-PET is currently available in the province only through clinical trials.

“My goal is to give Albertans options in the treatments they receive and to give them access to the most current and state-of-the-art treatments,” she says.

Photograph by Ryan Parker.

Rowe is an Albertan herself. She grew up in Calgary, where her father was an engineer in the oil and gas industry and her mom was an occupational therapist. She did her undergraduate studies in life sciences at Queen’s University in Kingston, Ont., graduating in 2006, then returned to Alberta to pursue her medical training at the U of A, first for her medical degree from 2006–2010 and then for her residency from 2010–2015. When it came time to choose a residency specialty, she was attracted to oncology because of experiences she’d had speaking to patients during her oncology rotation in medical school.

“Sometimes in medicine, we encounter scenarios that speak to us, and, for me, it was hearing the stories of patients going through this long journey. I’ve always been someone who likes to walk beside people in hard situations.”

Additionally, she liked the problem-solving side of being a radiation oncologist, where she has to figure out not only where cancer is and how to treat it, but where it’s going next.

After residency, she went to the prestigious National Cancer Institute (NCI) in Bethesda, Md. for four years, working first as a fellow, then as a staff clinician. Her fellowship research focused on prostate cancer and primary brain tumours (tumours that start in the brain), including studies on reirradiation (a second course of radiation treatment) and quality-of-life issues for patients. Her work as a staff clinician in the prostate cancer research group involved managing patients and running clinical trials, most of them involving PSMA-PET scans.

Rowe describes her time at NCI as a pivotal turning point: “That’s where my interest in research really took off. Just being around people who are constantly asking questions and having access to the newest technologies, it really gets your mind flowing.”

She came back to Alberta to be closer to family. She chose the Cross Cancer Institute because of her connections to the department; the excellent research structure set up by the Alberta Cancer Foundation at the Cross was another strong pull factor for Rowe. The Alberta Cancer Foundation funds an investigator-initiated trials (IIT) program there, and the Cross has an excellent clinical trials unit that helps run the trials. “It’s such a strong program, it really makes it easier to do research here,” says Rowe.

The Alberta Cancer Foundation is funding two of Rowe’s trials, one of which will start enrolling patients in 2024. Three hundred Alberta men with high-risk prostate cancer will participate over the next five years.

In this interventional trial, Rowe will use PSMA-PET scans to determine whether a patient’s cancer is in the prostate alone, has spread to the lymph nodes or has metastasized elsewhere. For patients whose cancer is localized in the prostate, the trial will examine whether they have a better outcome if their treatment plan includes radiation in the prostate alone or in a wider pelvic area. Patients whose cancer has spread to the lymph nodes will be treated with higher doses of radiation in the node area and will be followed over time to see which dose controls the cancer.

Her second trial will look at men who have high PSA levels after a prostatectomy (removal of all or part of the prostate). This trial will also use PSMA-PET to target radiation treatments, or to monitor men over time until there is an optimal area on which to focus the radiation.

“Hopefully, we will cure more people,” says Rowe, adding it’s also important to reduce toxicity and avoid the use of high-dose radiation in the wider pelvic area if it’s not needed, because the treatment can cause side effects such as urinary and bowel problems.

Rowe is also part of a trial running out of Montreal, with 700 patients across Canada, that is looking at how to tailor treatment for prostate cancer based on PSMA-PET scan results. 

Dr. Nawaid Usmani leads the group of radiation oncologists at the Cross Cancer Institute who treat prostate cancer. He is grateful for the expertise Rowe brings to the group from her time working with PSMA-PET at NCI. “It’s been great for her to use that experience and help springboard our local research program here,” Usmani says.

Usmani, who has been at the Cross for 16 years, says younger researchers like Rowe bring a lot of energy and enthusiasm to the group, and it’s infectious.

Her clinical trials using PSMA-PET are crucial, he says. “A lot of people are assuming that this imaging is going to help improve things, but we need the evidence. The clinical trials that Lindsay is doing are not only helpful for our patients, but they will actually be critical worldwide because they will basically demonstrate whether these treatments help improve patient outcomes.”

Photograph by Ryan Parker.

Three Questions with Dr. Lindsay Rowe

Can you describe what you do in 10 words or less?

I treat cancer with radiation, which is high-energy beams.

Where do you get your best ideas?

I’m lucky to be surrounded by colleagues and patients who ask me thoughtful and challenging questions. I learned at NCI that you just can’t ask the next question. You have to be three steps ahead of that.

If you weren’t in your current job, what would you be?

My plan if I didn’t get into medical school was to do a postgraduate degree and be a professor of anatomy.

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