Urology & Testicular Cancer Unit
Location: Royal Marsden
Section: NHS Clinical Research Programme
Head of Unit: Mr Alan Thompson
Urology Lead; NIHR Biomedical Research Centre: Professor David Dearnaley
This multidisciplinary Unit focuses on the management and research of patients with testicular, prostate, bladder and renal cancers. More than 1,000 new patients are seen annually. Urological surgery is based in Chelsea and the associated specialised ward also co-ordinates stoma care. The chemotherapy of testicular and bladder cancers is undertaken predominantly in Sutton with clinical research data co-ordinated by the Bob Champion Cancer Trust Research Unit. The problems of urological tumours are extremely diverse. For example, although uncommon, testicular cancers are the most frequent malignancy occurring in young adult males and are increasing in incidence. However, they are a model for chemo-sensitive cancer and the majority of men are cured. Prostate cancer is now the most common cancer in elderly men. Treatment of localised disease is highly controversial and progressive advanced disease is often associated with widespread incurable bone metastases.
The Institute and Royal Marsden teams have developed an extensive portfolio of clinical and laboratory research in urological cancers. An overarching aim is to exploit the close links between basic scientists at The Institute and clinicians in the RMH Academic Urology Unit to perform high-quality, multidisciplinary, translational research to improve the management of patients with urological cancers. Goals include:
- Optimising the local treatment of prostate and bladder cancers using surgery, radiotherapy and combined modality approaches with hormonal treatment and chemotherapy particularly developing radiotherapy using conformal (CFRT), intensity modulated (IMRT) and image guided (IGRT) techniques in prostate and bladder cancer
- Exploiting the potential of active surveillance of localised prostate cancer, both for the identification and validation of biomarkers of prostate cancer behaviour, and as a novel setting for tertiary chemoprevention trials
- Improving the outcome of patients with urological cancer through rational development of molecular targeted therapy
- Providing samples for translational research to develop tissue, serum and other markers to aid prognostication and prediction of outcome
- Identifying prostate and testicular cancer predisposition genes in order to develop targeted screening strategies and potential novel therapeutic targets
- Optimising chemotherapy and addressing survivorship issues to minimise the long-term risks of treatment of men cured of testicular cancer
- Explore and develop minimally invasive, laparoscopic and robotic surgical procedures in urological cancers
Relevance to the NHS Research and Development Programme
The Unit has large referral practices for prostate and testicular tumours as well as for bladder and renal cancer. The Unit is particularly fortunate in being able to take advantage of a broad range of clinical specialists excellently supported by specialised pathology and radiology services. Our research programme makes significant contributions to many areas of the NHS R&D priorities in cancer, including the study of the genetics of testicular and prostate cancer, conformal and intensity modulated radiotherapy, high-dose chemotherapy and peripheral blood stem cell support for testicular cancer. Also our studies on neoadjuvant treatments in prostate cancer, extending nursing roles, and psycho-social intervention in males with cancers in areas which qualify as very high or high importance to the NHS.
Recent Highlights
- The research plan for urological cancers formed a substantial component of the successful ICR/RMH bid for an NIHR Biomedical Research Centre. Urology Lead: Professor Dearnaley
- Successful Peer Review of South West London Urology Cancer Network led by Joint Cancer Centre/St George’s Hospital
- Mr Alan Thompson has succeeded Professor Dearnaley as Head of the Urology Unit
- Mr Christopher Ogden has been appointed as the new Consultant Urologist to the Royal Marsden Hospital and Epsom and St Helier Trusts. He will have responsibility for implementing and studying the value in urological cancers of the new Da Vinci robot which was purchased and installed in 2006
- Dr Robert Huddart has been conferred with the title of Reader in Clinical Oncology
- Dr Vincent Khoo has been appointed Director of the European Image Guided Radiotherapy (IGRT) Group
- Professor Dearnaley has been appointed to and Chairs the ICR/RMH Committee for Clinical Research and the SW Thames Cancer Network Urology Tumour Working Group
- Dr Chris Parker and Dr Johann de Bono have been appointed to the NCRI Prostate Cancer Clinical Studies Group and Dr de Bono additionally serves in the NCRI Translational Studies and ESMO Urological Oncology groups. Professor Dearnaley has become a member of the HTA Clinical Trials Assessment Panel
- New funding for national clinical trials have been awarded to: Dr Chris Parker, Chief Investigator of the MRC RADICALS trials of adjuvant therapy post-prostatectomy (4,000 patients, CTAAC funding) and is Principal Investigator (UK) for the ProStart trial comparing active surveillance with radical intervention options in localised prostate cancer (CR-UK Feasibility Studies Committee funding); additionally, he is Chief Investigator of an international multi-centre trial investigating the role of Radium 223; Dr de Bono has won MRC and PCRF grants to study PI3-kinase inhibitors and the cell culture of hormone refractory prostate cancer respectively; Professor Dearnaley has been awarded a CTAAC/CR-UK grant for the CHHIP programme (2,000 men) co-ordinated by the ICR-CTSU; Dr Eeles has initiated the international IMPACT study in prostate cancer targeted screening for BRCA1/2 carriers supported by the EU (39 collaborators, 23 countries)
- The 7th International Prostate Cancer Research Forum was hosted at The Institute (Professor Dearnaley - Scientific Chair)
- Plenary presentations were made by Dr Parker (active surveillance) at Prostate ASCO 2006 and by Dr de Bono (new drug targets - abiraterone) at ASCO and AUA
- Conference merit awards were won by our Research Fellows: Gerthard Attard (Prostate ASCO, ASCO) and Rhoda Moliffe (Prostate ASCO)
- The NCRI Translational programme has identified the biomarker E2F3 as of prognostic significance in bladder and prostate cancer
Future Aims
The Male Cancer Research Centre, “Centre of Excellence” Collaborative Grant (Lead: Professor Colin Cooper) and Everyman Campaign give unique opportunities to develop public awareness of male cancers and to translate high quality laboratory research into clinical benefit for patients. In prostate cancer we aim to develop genetic markers to determine the natural history of disease on an individual basis, so as to select appropriate management policies. Genetic studies will continue in both testicular and prostate cancer with the aim of identifying the gene(s) responsible for familial cancers. The Unit is ideally placed, because of its strong links with the Joint Department of Physics and large prostate cancer referral practice, to continue its national role in developing and assessing the use of conformal and intensity-modulated radiotherapy in localised prostate cancer. The strengthened links with the CR-UK Centre for Cancer Therapeutics and collaborative work with Dr Johann de Bono has already led to a rapid expansion of Phase I/II study activity. Further studies are planned with the t abiraterone acetate, a compound generated by Institute chemists to inhibit androgen synthesis by blocking 17-alpha hydroxylase. A new collaboration with Professor Freda Stevenson's group in Southampton is assessing the activity of a DNA anti-PSMA vaccine in recurrent prostate cancer. Novel studies are commencing evaluating circulating tumour cell numbers as surrogate endpoint for clinical trials which may also be developed into a method to assess targeted drug therapies. The Active Surveillance Programme led by Dr Chris Parker will give new insights into disease behaviour and correlate predictive factors including tissue hypoxia and proteomics with disease progression and lead to opportunities for novel interventions.
In the NHS Clinical Research Programme
