For most men, when their localised prostate cancer is treated, they can have the peace of mind they’ve been cured for life. But for some men, especially those with more aggressive forms of the disease, a first treatment isn’t the end of their story with prostate cancer. We’re funding Professor Choudhury to run two research projects, to try and understand why some men’s prostate cancer comes back, and what we can do about it if it does.
Recurrent prostate cancer – that is, disease that comes back after a first treatment, is in reality cancer that was never successfully treated in the first place. In some cases, this might be because the cancer had already escaped the prostate before treatment, but was undetectable on scans. In other cases, some particularly resilient cancer cells may have survived the first treatment, only to rear their ugly head again later.
The truth is, we don’t know enough about why either of these scenarios present themselves, or how we can stop them from happening. What we do know is it’s men who are paying the price.
Luckily, Professor Ananya Choudhury from the University of Manchester and Christie Hospital NHS Foundation Trust is on the case. We’re funding her to carry out two projects, which tackle recurrent prostate cancer from both sides of the problem.
Professor Choudhury is a clinical oncologist and researcher, who describes her area of expertise as “personalised radiotherapy”.
“Radiotherapy is a really good treatment for localised prostate cancer”, she explained. “We know that for men with low or intermediate risk disease, radiotherapy will cure nine out of ten of them first time around.”
“But for men with aggressive, higher-risk disease, while radiotherapy is still as good as other treatments, the success rates aren’t as high – we can only cure two out of three men.”
“The trouble is that we don’t know how to spot the men we can cure and from the men we can’t. Our research is aimed at trying to figure that out; to explore whether we can find smarter ways of at least being able to tell patients what their chance of cure are, but also to find the patients who might not be cured with radiotherapy alone, to see if we can offer them something in addition to increase the chance of radiotherapy being successful, and to stop their cancer from returning.”
In her first (Movember funded) Prostate Cancer UK project, Professor Choudhury is tackling those extra hardy cancer cells that somehow resist the effects of radiotherapy. She thinks this might have something to do with levels of oxygen in men’s tumours.
She explained, “As some tumours get bigger they’re able to attract less and less oxygen deep into the tissue. A lack of oxygen changes the genetics of the cells deep in the tumour, so they become more likely to spread and be resistant to treatments like radiotherapy.”
“So, we wanted to see whether we could find those men with low-oxygen tumours, whose cancer was more likely to come back after radiotherapy. We developed a test that we think identifies low-oxygen tumours, and now we’re validating that in hundreds of prostate cancer samples. We’re doing the final steps in that validation now, and I think within the next 12 months we’ll have a good steer as to whether we’ve got a robust enough test that we can take it into clinical trials.
But what can we do for the men we identify whose treatment isn’t likely to be successful?
“These men may be better suited to chemotherapy instead. Or, and what I think is most exciting, we have ways to boost oxygen levels in tumours, and make them more sensitive to radiotherapy.”
“So far, studies in bladder cancer have shown taking a tablet to increase the blood flow and therefore oxygen levels in the tumour makes radiotherapy work better. So we’d like to see if this could be true for prostate cancer patients too.”
But what about the other group of men whose cancer comes back? The men whose prostate cancer cells may be sensitive to radiotherapy, but aren’t hit by any radiation because they’ve started to escape outside the prostate.
Professor Choudhury’s second Prostate Cancer UK grant is looking just at that. She’s collected data from men who’ve had all sorts of radiotherapy treatments, like brachytherapy, external beam radiotherapy, or a combination of both, and where it’s been delivered.
“We’re using very advanced analytical techniques like artificial intelligence and machine learning to map the dose of radiotherapy each man received, and compare it to his outcome,” she told us.
“We want to see if we can identify when there are areas within the prostate that would benefit from a bigger dose of radiotherapy, or if we can work out which patients would do better with a particular type of radiotherapy, or combination of treatments or techniques.”
“The best thing about these two projects is that we can already see how to bring them together,” explained Professor Choudhury.
“Once we’ve worked out which men respond best to which radiotherapies in the second project, we can apply what we’ve learned about the biology of recurrence in the first project.”
“In the future, perhaps we could design a clinical trial that will tackle the problem from both sides to improve the outcomes of prostate cancer patients even more.”
“Without the support of all the people who donate their hard-earned money to Prostate Cancer UK, I wouldn’t have the team that I have, doing the work that we’re doing. And if we couldn’t do that work I wouldn’t be able to offer that potential of hope to the patient sitting in my clinic.”
“None of this would be possible without generous donations and the belief that Prostate Cancer UK supporters have in the work that we do.”