Professor Robert Winston chaired a panel of leading cancer specialists last night to discuss how our new 10-year strategy to tame prostate cancer can be turned into clinical reality. From robotic surgery to genetic testing, here’s what the experts say will work.
Leading scientists and clinicians at London’s City Hall last night hailed our plan to halve increasing prostate cancer deaths within a decade as “game-changing”. At a special panel discussion to launch our new 10-year strategy, chaired by Professor Robert Winston, the cancer specialists unanimously backed our ambitious target of cutting the 14,500 men expected to die from the disease in 2026 to even less than the 10,900 it kills annually today.
But how can we do it? That was the question Professor Winston put to the panel in a lively exchange that saw a range of ideas put forward, from increased use of robotic surgery to the screening potential of a new risk assessment tool for GPs.
For the former GP, Professor Martin Roland, the priority should be identifying which cancers are aggressive and which could be left untreated – like his father’s, who died of other causes aged 101. “We need to catch the killers sooner,” he said.
Drug researcher Professor Johann de Bono agreed and suggested targeted screening could help, using numerous clues in our genes to predict how susceptible a man is to the disease.
“As many as one in seven men may have inherited defects in the machinery that repairs their DNA, who are therefore at far higher than average risk of prostate cancer,” he said. “These sorts of genetic defects can be detected in the blood and urine and are often present from birth. It isn’t a huge scientific leap to think about finding these men and introducing targeted screening for them. There’s research underway to see if it could save lives.”
After we’d just announced funds to develop a revolutionary new prostate cancer risk-assessment tool for GPs, our Director of Support and Influencing, Heather Blake, was keen to stress that any kind of diagnostic tool must have the confidence of those being tested. “What’s really important about this tool is that it must work for men – that will be the key to getting it adopted on a wider scale,” she said. “It has to be something that men feel is right for them.”
But men diagnosed with aggressive tumours, or whose disease comes back after treatment, will only be saved if we get better at treating advanced prostate cancer. And genetics researcher, Professor Charlotte Bevan, believes precision medicine holds the key to future treatment.
“That means two things,” she explained. “First, precision in our use of biomarkers and understanding the clear link between the markers we’re looking at and how they drive disease. Then secondly, being precise in how the treatments we develop target the cancer, so that they hit the tumour with only minimal damage to surrounding tissue, which should in turn reduce side effects.”
Oncologist, Professor Malcolm Mason, added a different definition of precision, saying it’s increasingly important to understand which men will benefit from the treatments available so that they get the right drugs at the right time.
“The STAMPEDE trial showed unequivocally that, if we give chemotherapy earlier on, men live longer,” he argued. “But chemo is scary. It’s horrible. No oncologist will try to tell you otherwise. And it isn’t for everyone, so it’s essential that we find out who would benefit most from treatments like this.”
Fellow oncologist, Professor Joe O’Sullivan, pointed out how the clinical trials used to investigate these questions often had the added benefit of improving patient care, too. “Clinical trials change practise over all by showing what the best care looks like,” he said. “But they’re also a hugely rewarding means of delivering gold standard care to the men who need it most, in a way that’s cost-effective to the NHS.”
NHS delivery is, of course, a key requirement for our new strategy to work. Professor of Cancer Nursing, Alison Richardson, stressed the importance of investing in implementation if scientific discoveries are to get out of the lab and into the hands of front-line doctors and nurses. “They have to be ready for the changes these discoveries will bring about,” she said.
As chief executive of NHS Providers, Chris Hopson accepted criticisms of the NHS being slow to adopt changes in the past. But he highlighted the key role that charities can play in this, saying: “Organisations like Prostate Cancer UK, who can argue really strongly for a single cause, have a fundamental role in not just bringing in the money, but in prodding big, unwieldy organisations like the NHS to respond to change and improve.”
Among those in the audience asking questions from the floor was Kurt Jewson, whose photos after surgery for advanced prostate cancer recently went viral on Facebook. His dismay with GPs’ reluctance to offer the PSA test to men under 50 sparked a debate among the panel as to the benefits and dangers of mass testing, and the need for better education of both the public and health professionals about the risks involved.
In the end, it was our Director of Research, Dr Iain Frame, who best summed up what the ideal blood test of the future might look like. “We need a man to be able to have a single blood test that will not only diagnose his cancer, but if it’s aggressive, will direct him towards the most appropriate treatment for him,” he said. “Science can deliver this, and it is up to us now to co-ordinate that delivery.”