Pelican no longer funds research into prostate cancer.
Pelican supports research that informs and improves prostate cancer detection and treatment today.
The charity is committed to improving the lives of men with prostate cancer by funding innovative research projects that investigate precise treatments, such as focal therapy. We are particularly interested in treatments with less severe side effects.
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NYU Langone Medical Center, New York attended by 30 delegates (28 pictured, including Pelican Chief Executive Sarah Crane)
In males in the UK, prostate cancer is the most common cancer, with around 47,200 new cases in 2015 and over the last decade, prostate cancer incidence rates have increased by 6% in males in the UK[1]. Prostate cancer survival is improving and has tripled in the last 40 years in the UK, however remains the second most common cause of male cancer death, with around 11,300 deaths in 2014[2]
Pelican Cancer Foundation has had a long term interest in more precise diagnosis and treatment of prostate cancer. In 2012 an international collaboration meeting was called and hosted by Pelican, with specialists from around the world gathering in New York (USA) to discuss and define standards for a study assessing MR target biopsy. Following a further two years of development the clinical trial PRECISION[3] was launched. The trial was seed funded by Pelican and with such great international interest in this area, uptake to the study was rapid and 25 centres from 11 countries recruited patients.
The NHS Vanguards[4] are publishing a new prostate cancer pathway that includes MRI before biopsy and are keen to standardise processes and develop protocols to coincide with national guidelines; however due to the fractured nature of NHS networks the universal and uniformed rollout of a programme would be unlikely.
Pelican Prostate Cancer Programme – influencing, helping and informing
A national programme would contribute to the comprehensive roll out of cost saving measures identified by the National Institute for Health and Care Excellence (NICE) in their 2014 commissioned guideline, Prostate cancer: diagnosis and management[5] and supporting Costing statement: prostate cancer: diagnosis and treatment[6], which recognises that savings are feasible in the following areas:
- Not offering another biopsy if the results of a multiparametric MRI are negative;
- Using multiparametric MRI may reduce the number of investigations to diagnose prostate cancer;
- Earlier diagnosis may reduce the need for expensive treatments for prostate cancer at advanced stages.
The changes in treatment pathway are challenging and uptake has been variable across the country however, Pelican believes the programme can not only increase clinical confidence and better outcomes for patients, but also long term savings for the NHS.
A prostate cancer, national MDT development programme has been welcomed by urologists and specialists in this field. An initial meeting identified the aim of the programme is to help multidisciplinary urology specialists develop as unit, to understand the changes to the prostate cancer pathway and work together to develop their local and regional strategy so that patients receive the best diagnosis and treatment at the best time for them.
There has been an increase in the number of men diagnosed with prostate cancer, but the number who die from prostate cancer has remained constant. We believe this demonstrates more men with low-risk cancer are being diagnosed and treated without receiving any survival benefit. The issue is that the effects of some prostate cancer treatments can have a negative impact on quality of life.
Recent publications (PRECISION) have shown that using high quality MRI before a biopsy can help men avoid a biopsy (ask any man if this is a good idea!) and avoid over treatment whilst also detecting more significant prostate cancer which has not been detected on traditional TRUS guided biopsies.
This is a major change in the prostate cancer treatment pathway. There has been a lot of publicity but this is complex to implement and challenging to change current practice.
The NHS is under enormous financial pressure and units are very concerned that this change will involve extra costs and capacity for urology teams, in particular the radiology departments.
There are solutions and rational arguments for making these changes which will benefit many men. Therefore Pelican Cancer Foundation, with the help of an eminent steering group from hospitals around the UK, is funding a national development for all urology departments in England, Scotland, Ireland and Wales.
Footnotes:
[1] 2 Cancer Research UK, www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer#heading-Zero, Accessed March 2018
[3]PRECISION (Prostate Evaluation for Clinically Important Disease: Sampling Using Image Guidance or Not?) trial aimed to evaluate prospectively whether multiparametric MRI, with targeted biopsy in the presence of an abnormal lesion, was noninferior to standard transrectal ultrasonography–guided biopsy in the detection of clinically significant prostate cancer in men with a clinical suspicion of prostate cancer who had not undergone biopsy of the prostate previously.
[4]In 2015 the NHS established ‘vanguards’ for new care model models that development a blueprint for the future NHS and care services and established 50 across England to support improvement and integration of services
[5]www.nice.org.uk/guidance/cg175/evidence/full-guideline-191710765
[6]www.nice.org.uk/guidance/cg175/resources/costing-statement-pdf-191671885
