How do you balance your time when you are a doctor and a researcher? How can we make the biggest difference to men with prostate cancer? We speak to Professor Hash Ahmed about his work that led to the introduction of mpMRI scans before biopsy and the next big thing that he wants to achieve.
Hash Ahmed is a consultant urological surgeon based in Charing Cross Hospital. He meets with men every day to guide them from prostate cancer diagnosis to finding the best treatment for them, but he’s also a researcher. As Professor of Urology at Imperial College London, he’s been on a 10-year mission to make the biggest difference he can for men. And for Professor Ahmed that means one thing: delivering practice-changing clinical trials.
Professor Ahmed runs clinical trials that span all aspects of managing prostate cancer, from improving diagnosis to giving men better treatments. Now, we’ve funded him in our latest round of Research Innovation Awards to carry out the pilot trial which could bring focal therapy – treating just the cancer and leaving the healthy areas of prostate untreated – to more men.
I've been doing research for probably the last 10 years jointly with clinical practice and it’s a 50-50 split. My guiding principle is to have a clinical trial that’s suitable for every patient I meet – wherever he is in his prostate cancer experience. This interaction with patients is so important. Both to me and to my research. It reminds me why I’m here, and helps me to keep sight of what’s most important for men, so I can design studies that directly link in with what patients say is important to them, and would improve their prostate cancer experience.
My interest in research started with focal therapy when I was working as a research fellow at UCL with Professor Mark Emberton. We set up trials that were really the foundations of focal therapy in prostate cancer.
We first showed that if a man has cancer on one side of his prostate, we can treat just that one side and get good cancer control and few side effects. But we realised we couldn’t deliver more specific focal therapy, to just the areas with cancer, without having a good way to image the prostate. That led us to the PROMIS trial, where we showed an mpMRI scan can be used to pinpoint where in the prostate the cancer is. Now that’s established as a gold-standard imaging technique, it means we have the tools in place to think about how to treat the cancer more precisely.
Focal therapy will deliver a huge shift in prostate cancer treatment. Not everyone may realise it yet, but it’s going to have a massive impact. The first step is CHRONOS, the trial I’m starting that is funded by Prostate Cancer UK’s Research Innovation Awards. This is a pilot trial, where we’ll be testing focal therapies against standard treatments to the whole prostate, on a small scale. If this is successful, we’ll be able to run a larger trial that could prove focal therapies should be a widely available treatment option in the UK.
Getting change quickly into practice is what drives me. There's nothing wrong with doing long-term, blue-sky research – I benefit from it because I can use the findings from that to do the trials. But it’s the trials that get changes into clinical practice, and as a medical doctor, that’s what I’m most interested in. Funding research like this is vital. We don’t have all the answers, but among the ideas will be the nuggets that lead to huge transformations.
I think it has to be the PROMIS mpMRI trial. It was tough – it required personal push almost every single week to recruit patients and engage with the centres running the trial. It was difficult and there were a lot of points where it almost failed. But it was worth it. Now this technology is changing the lives of men around the world.
With the kids at home. I have a four-year-old and a nine-year-old, so there is very little time to do anything else! I like to spend time in the garden though. I’m growing some flowers and some vegetables, and that helps me relax.
I hope that in 10 years’ time we’ll have a national screening programme for prostate cancer. I hope we’ll have delivered the evidence, through research, that proves screening is the right thing. It will be a lot of work, but I think it’s possible.
We awarded funding to Professor Ahmed to run the CHRONOS trial which is due to start in July 2019. When the trial opens recruitment we will update where it is available on our new clinical trials map.