UPDATE - Issue 21 - Spring 2005
£370,000 for research and training
In March, Prostate Research Campaign UK announced further grants of £370,000 for research into all prostate disease. Of this, over £300,000 will be allocated for research with the balance going to the training of a wide variety of health professionals, including specialist urology nurses and doctors and GP nurses country wide. Nine separate research grants were awarded and among these, Professor Neil O'Donoghue FRCS describes five of them.
Responses to irradiation
It is now well established that some families have an inherited predisposition to the development of breast and prostate cancer. We already know that a small proportion of younger men with prostate cancer carry a mutation of the BRCA2 gene and are relatively resistant to radiation therapy.
Dr Eeles and colleagues at the Institute of Cancer Research plan to study a unique population of male BRCA2 mutation carriers with a substantial risk of developing prostate cancer at a younger age which should provide information on the genetic pathways involved and on their responsiveness to radiotherapy.
Mr Sampi Mehta, one of our research grant recipients,
threatens our President Tony Kilmister with an imaging
transducer during his visit to the University of Sheffield
The role of Insulin Growth Factor
Advances in molecular biology have lead to the identification of growth factors within tissues which influence the continued growth of cells and a number which play a role in the uncontrolled growth of cancer cells. One of the best known is vascular endothelial growth factor which plays a critical role in the development of new blood vessels which are essential for cancer growth and which has led to trials of new agents in therapy. The Oxford group led by Dr V M Macaulay have demonstrated the presence of insulin-like growth factor Type 1 which is present in increased amounts in prostate cancer as compared to benign prostate tissue and is reported to become more active in the latter stages of rapidly progressive hormone resistant prostate cancer. This grant for £47,492 is to allow Mr Ben Turney to continue this work in the laboratory using biopsy material from patients and animals.
Genetic changes in Prostate Cancer
If we had better methods of predicting outcomes and distinguishing between the tigers and pussy cats of prostate cancer we would know better which patients require radical prostatectomy, radiotherapy, brachytherapy, cryotherapy, high intensity focused ultrasound or can be monitored by active surveillance.
Cancer is due to the progressive accumulation of genetic changes within cells. Early change is associated with local growth within the prostate and further genetic changes allow local extension outside the prostate and eventually spread to distant sites. Mark Feneley and colleagues at the Institute of Urology plan to study the genetic changes in men who have done well following radical prostatectomy and in men who have developed early recurrence. The aim is to develop a molecular genetic test to guide our management.
Work with stem cells
Many patients on hormone therapy will relapse and develop hormonal escape. The outlook for such patients has been bleak until the advent of evidence last year that docetaxel based chemotherapy regimes can achieve a significant survival advantage.
Johann de Bono and colleagues from the Institute of Cancer Research and the University of York are proposing a novel approach to hormonal escape by isolating prostate cancer stem cells from benign prostate tissue, hormonal sensitive and resistant prostate cancer. The technique of isolating stem cells from the prostate may perhaps provide a key to greater understanding of the molecular biology of the prostate and stem cell cultures provide a method of testing new molecular targeted drugs in the laboratory.
Imaging for BPH assessment
In current clinical practice we use relatively simple ultrasound techniques for visualising and assessing the volume of BPH (Benign Prostatic Hyperplasia) patients' prostates. There has been relatively little research in the use of more sophisticated imaging such as MRI.
The prostate is composed of glandular tissue embedded in a fibro-muscular stroma and produces the major proportion of semen. BPH develops in the transitional zone of the prostate close to the urethra and is characterised by a variable increase in prostate volume and a relative increase in the fibro-muscular stroma over glandular tissue. This expansion in prostate volume may obstruct urinary drainage and produce the common clinical symptoms of the disease. David Buckley and Charles Hutchinson from the University of Manchester are proposing to use sophisticated MRI scanning techniques to study (1) volume changes (2) blood supply and (3) relative changes in stroma and glandular components in BPH. It is expected that this will provide new insights into BPH and lead to new methods of assessment of response to therapy.
Training
Finally, we mention one of our training grants. 44 year old consultant urologist Chris Anderson has just spent a month at the University Clinic in Leipzig in Germany, studying innovative laparoscopic surgical techniques and operating under the guidance of world-authority Professor Gens-Uwe Stolzenburg.