Searching for the best possible outcomes, every patient I have treated since 1989 has been monitored. Tissue and more recent blood samples have been kept on everybody. We follow up each patient through my research team to see how he is travelling in his journey to recovery and beyond. My major research initiative currently is to look at optimising quality of life in patients after each one of their treatments, correctly selecting the right treatment to tailor treatment, bringing in new treatments which are less invasive with less side effects selectively, improving diagnostic tools using multiparametric MRI and improved targeting of cancers with precision biopsy. A summary of the projects that I am looking at carefully at the moment are given below.
Not only focusing on my patients, I believe that collaboration is needed in the global fight against prostate cancer. Working with a range of individuals and organisations, I drive a research fellowship program to ensure that we continue to learn about prostate cancer and improve diagnosis, treatment and prevention. Recently, I was appointed the Clinical Director of the Australian Prostate Cancer Research Centre – New South Wales by the Federal Government of Australia and this allows me to coordinate prostate cancer research across the St Vincent’s Campus, Garvan Institute,Kinghorn Cancer Centre , Royal Prince Alfred and Royal North Shore and in collaboration with our Melbourne, Queensland, Adelaide and South Australian colleagues. In addition, I work with the Memorial Sloan-Kettering Centre in New York, Cornell University and the Robotic Institute in Florida as well as Beth Israel in New York and the University College Hospital in England.
Working with the Garvan Institute of Medical Research, I have assisted in the establishment of a massive prostate tissue bank and database. This is the largest in the southern hemisphere. Funded through a $2 million NH&MRC enabling grant, the Australian Prostate Cancer Collaboration via resources is assisting in research into the diagnosis, treatment and prevention of prostate cancer as it makes fresh tissue and more so the clinical data essential for research.
Currently, I work with Memorial Sloan Kettering Cancer Centre, New York, Cornell University and the Robotic Institute in Florida.
Working with the Garvan Institute of Medical Research, I have assisted in the establishment of a massive national prostate tissue bank. Funded through a $2 million National Health and Medical Research Enabling Grant, the Australian Prostate Cancer Collaboration Bio-Resource is assisting in research into the diagnosis, treatment and prevention of prostate cancer, as it makes available fresh tissue, and more so the clinical data essential for research.
- Is there a significant benefit to performing a robotic radical prostatectomy compared to other techniques such as open and laparoscopic radical prostatectomy?
- Can we predict which treatment for localised prostate cancer gives the best quality of life and cure rate and personalise this choice to maximise quality of life and also cure rate in individual patients?
- Can multiparametric MRI of the prostate avoid unnecessary biopsies in patients with an elevated PSA and more accurately detect and target significant high-grade prostate cancer?
- Is transperineal biopsy of the prostate safer and more accurate than transrectal biopsies of the prostate in the detection of prostate cancer?
- Are there better and more accurate imaging techniques to detect microscopic secondaries to lymph nodes or bone than our current use of CT scan and bone scan? In particular, can F-18 PET CT scan better detect bone secondaries, and PSMA PET CT scan and Combidex MRI better detect secondaries in lymph glands? Finally, will these more accurate tests allow more accurate targeting of therapies such as stereotactic radiation therapy?
- Can patients with low-risk prostate cancer be more accurately and less invasively monitored with MRI and other techniques such as circulating tumour cells and genetic markers within the tissue around the cancer? Can some patients be totally reassured that no further active monitoring is required?
- Can a new technique of sparing the bladder neck or forming a valve at the bladder neck in robotic surgery improve the earlier recovery of urinary control after surgery?
- Is it possible to treat just the cancer inside the prostate and not the whole prostate gland in selected patients who have small localised prostate cancers? Furthermore, how do we best predict who is appropriate for this type of treatment and it is likely to be successful in the short and longterm?
- Can we use better MRI techniques to improve the accuracy of detecting significant prostate cancer?
- Can we improve the cure rate for surgery in prostate cancer in more aggressive forms of prostate cancer by giving chemicals before the surgery?
- Can we predict the behaviour of individual patients with prostate cancer more accurately using a new technique using microRNA in the circulating blood?
- Key update in education for general practitioners in prostate cancer and benign prostatic hyperplasia.
- How can we use PSA more effectively to avoid overdiagnosis and appropriate detection of prostate cancer?
- Can we predict who to give radiotherapy to after radical prostatectomy?
- Can we predict who is going to fail after low dose rate brachytherapy (seeds)?
- Can we use the more accurate techniques of radiation therapy (VMAT) to improve the technique or irradiating the prostate and also the lymph nodes to improve the cure rate of more advanced prostate cancer? We particularly looked at the safety of extending the area of radiotherapy to the lymph nodes higher up the lymph node chain.