ISSUE 11 PREVIEW: This article will be found in EYES IN Magazine, Issue 11 available in December 2011 on the EYES IN app currently available in the Apple market.
A new study has shown that a new treatment using sound waves to target prostate cancer reduces the risk of harmful side effects caused by current treatments. Researchers at University College London have shown that High Intensity Focused Ultrasound, or HIFU treatment, is able to target the tumor alone so that there is less tissue damage compared to traditional surgery or radiotherapy. This focal therapy has been shown to reduce risks dramatically.
Men with early prostate cancer have the choice between surgery or radiotherapy that destroys the whole prostate – by so doing, it causes a lot of collateral damage to sensitive tissues like nerves, blood vessels, back passage and muscles that control urine flow. This can lead to side-effects, such as urine leakage that results in needing pads (in 5-20%), impotence (in 30-60%), and back passage problems (e.g., diarrhea, bleeding, pain in 5-20%). The new study, funded by Pelican Cancer Foundation and a number of other partners, has shown that only 5% of men have incontinence and problems with their erections. None had back passage problems. This was a small study of 20 men looking at whether side-effects were lower than traditional treatments but the early cancer control was also impressive – 90% of men had no cancer on tissue samples taken after treatment, whilst 100% had no important cancer.
The lead author of the study, Dr. Hashim Uddin Ahmed, Clinical Lecturer in Urology, said, “Prostate cancer has a long natural history – this means that the cancer grows slowly. Current treatments cause a lot of harm so focal therapy offers the balance between treating the cancer and minimizing the collateral tissue damage. It is the tissue damage to nerves, back passage and blood vessels that causes the side-effects. By targeting and destroying only the cancer areas, damage is minimized.”
Professor Mark Emberton, Chief Investigator for the study, stated, “Our early trial results have shown that 95% of men have none of the long term problems associated with the more invasive treatments such as leaking urine or poor sexual function. This cannot be achieved by any other standard treatments. Early cancer control was also very encouraging, but more work needs to be done to look at this.”
Dr. Ahmed is an MRC Clinician Scientist and Clinical Lecturer in Urology at University College London. Hashim qualified from Oxford Medical School where he received the Osler Prize in Medicine and twice received the Worshipful Company of Cutlers’ award. After pre-registration house jobs in Birmingham’s University Hospitals (Liver Transplant Unit) and Manchester’s Royal Infirmary (Renal and General Surgery) he was an anatomy prosector at Oxford teaching anatomy to preclinical medical students. He carried out senior house jobs in surgery on the Royal Free Hospital rotation and then a the Pelican Cancer Foundation Research Fellowship with Professor Mark Emberton at University College London at which time he started a number of imaging and focal therapy trials were started.
Ahmed's research interests are in Health Technology Evaluation focusing on high intensity focused ultrasound. He has run three phase I/II clinical trials evaluating the role of focal therapy in prostate cancer and is Co-PI in a multicentre UK trial evaluating HIFU focal therapy. He has published widely on the role of HIFU and other minimally invasive techniques. He has spoken on the subject in many national and international conferences in the USA, Spain, Germany, Sweden and Portugal. He has performed over 300 HIFU procedures.
An Interview with Dr. Hashim Ahmed
-As a child, what did you want to become (profession-wise)?
I went through the usual childhood preoccupation with being a policeman and fireman, but as I was going through my secondary comprehensive education I realized I had a knack for science and mathematics whilst also enjoying the arts, in particular history. We did a module in the history of medicine during one term in history and I thoroughly enjoyed it. This early sojourn through how medicine evolved, innovated, and changed together with the rigor of evidence that is required in history and my enjoyment in the sciences meant there was only one profession that would meet all of my interests. Medicine was a natural bedfellow. As per the low expectations that many comprehensives had for their pupils, in particular those from immigrant backgrounds, my careers advisor suggested I keep an alternative (I think he regarded it as his primary recommendation) in being a food technician.
-In which town did you grow up?
I was born in Bangladesh in the North-East Sylhet region in a town called Maulvi Bazaar. My family came over to the UK to Birmingham when I was 3 years old and I grew up in Birmingham where I went to school and did my A levels.
-Do you think your background has influenced your chosen profession in healthcare? If so, what specific element in your background is most pervasive in influencing your current approach in your healthcare profession?
My father was a bright man but came over to the UK at the age of 16 as a laborer. As many families from the Indian Sub-continent, education was regarded as the key to move forward, but unlike many of his compatriots who needed their children to work as soon as compulsory education was over, my parents were keen that we continued and encouraged us to do so. I realize now looking back that my father struggled financially – looking after us and the extended family back in Bangladesh, but he never made me feel that I should drop education to start working. I was never asked to go into one profession over another, only to work hard at whatever I did, but my parents were obviously delighted I chose the path that I did.
-What inspires you in the job of being a doctor/researcher?
I have been fortunate that what I do not only helps many people in a real way with their medical problems but also that by combining it with clinical research I can see novel and innovative ways of changing our current practice so that it benefits the patients I see. Since I do clinical research those benefits can be seem immediately, so that the area I am particularly working on – prostate cancer diagnosis and treatment – could see a paradigm shift in current practice within the next 5 years as a result of the efforts of our research group.
-In which way do you consider yourself an innovative creator?
My mentor, Professor Mark Emberton, has inspired the innovation and creativity in the work that I do. His mind is constantly looking at new ideas, pushing boundaries and asking difficult questions. I sometimes find it difficult to keep up with him, to be honest, but if I can even come up with a fraction of the ideas he has, then I might be deserving of the label of innovative creator.
-What do you consider as a masterpiece you have created or worked on in your healthcare field?
We conducted the first trial in the field of focal therapy in prostate cancer. This required an innovative approach, masterful planning and bloody-mindedness to achieve. The background to this is as follows: At present, men with low to medium risk prostate cancer choosing to have treatment, can undergo surgery or radiotherapy. Both of these destroy the whole prostate regardless of how much cancer there is. By so doing, considerable collateral damage can be caused to sensitive tissues like nerves, blood vessels, back-passage and muscles that control urine flow. This leads to side-effects such as urine leakage needing pads (in 5-20 per cent of men), impotence (in 30-60 per cent) and back passage problems (diarrhea, bleeding, and pain in 5-20 per cent). Overall, only 50% of men undergoing surgery can achieve the trifecta perfect result.
Our trial looked at treating only the area of the prostate involved with cancer and not the whole-gland. The treatment we used was called High Intensity Focused Ultrasound or HIFU. This uses soundwaves to heat up the prostate to temperatures which can reach 80-90 degrees centigrade. How does it do this? If you can remember that as a child, many of us used magnifying glasses to concentrate the sun’s rays to burn a piece of paper. Well, this is how HIFU works, only it uses soundwaves. Anything in between the HIFU probe and the target in the prostate is not affected, but at the target the tissue ‘boils.’ After 12 months, 90 per cent achieved the perfect result – called the trifecta status - of having no urine leak, having good erections and cancer free. In fact, 95 per cent of the participants were able to maintain erections sufficient for intercourse and no participants reported back-passage problems. Early cancer control was also very promising. Ninety per cent of men had no cancer on tissue samples taken after treatment, while 100 per cent had no important cancer. As a result of the findings from this study, a larger study in over 120 men is now being run across the UK, lead by our group, to test whether these results are reproducible across the NHS.
-Did or do you have any other creative ambitions or dreams to which you aspire?
I have always had an ambition to learn to fly. When I have more time, perhaps I’ll take flying lessons and get my license.
-How did you get the idea for your profession in healthcare?
Urology is full of technology to help the surgeon. Whether it is to treat the prostate with HIFU or cryotherapy or radiation or remove the prostate with a robot, to treating stones with lasers. This marriage between technological innovation and a constant desire to push the boundaries to aid the surgeons’ hands very much attracted my attention. It still does and I have no regrets in choosing this specialty.
-Do you have a favorite healthcare professional or institution you look up to yourself?
When I was a student at Oxford, Sir Peter Morris was Nuffield Professor of Surgery. He was truly inspiring, even from the distant gaze of my medical student eyes. He was kind, gentle, and fiercely open-minded. He was a pioneer in renal transplant surgery and respected across the world.
-Are you ever afraid you will run out of inspiration in your job?
I think everyone has to be, as is it human nature. However, medicine is such that incremental improvements in how we treat the patients in our care are constantly needed. If we aspire to keep our patients’ needs at the heart of our work vocation then that inspiration will always return to burn brightly after a dim period.
-What is the most difficult thing in your job?
It is the balance between prioritizing family and friends, who must come first, clinical practice in which I have direct patient care and striving to meet my research aims. The latter two are particularly difficult as your masters in clinical practice in the NHS have very different criteria by which they measure your impact and success compared to your masters in the academic arena. The two can often conflict but only because many don’t understand that you must fulfill your obligations in both arenas of work.
-What is the most fun part of your job?
Sitting in a meeting where someone suddenly has a fantastic idea. Then sharing in the process by which we strive and work as a group to make it happen.
-Do you expect your health care profession to change in the future?
It must to survive. One of the greatest challenges in my area of research is the professional resistance that we see to innovation. Yet, it was only by challenging dogma that we have achieved such profound innovations as coronary artery stents, artificial hip replacements, lumpectomy in breast cancer, lasers to treat kidney stones, endoscopic surgery, and so much more in surgical innovation. I think many of our profession think that the natural response to something new is skepticism rather than embracing the philosophy that ‘we must ask the question in order to know the answer.’
-Do you embrace the changes in the health care industry regarding social media and technology influences?
I guess I must, considering what I have said already! I am unsure how social media will impact on my practice but already I am seeing signs of it. Men are sharing their experiences with others around the world – telling them of our work at University College London – and more importantly, spreading the message that the current standard of care is not something that men must necessarily accept or embrace. These social networking groups may in the future have tremendous weight in the consultation that a patient has with his/her doctor.
-What do you consider to be your greatest achievement?
Other than my family, I have recently been successful with a personal award from the UK’s Medical Research Council. This Clinician Scientist fellowship for 5 years gives me £1.2Million, is awarded to only ten physicians in the UK across all specialties and gives our group at UCL the recognition that what we are doing meets with national priorities for research.
-Do you like art? Do you have any preferences for an artist? And/or for creators of artistic work? (Creators can also be chefs, designers, photographers, fashion designers, or inventors.)
I have always admired and enjoyed the music created by Cat Stevens. There was a spiritual depth to his work that resounded with me. Later in his life he converted to Islam, to become Islam Yusuf, and continues to offer renditions of his old work and create new ones with that beautiful voice of his.
-If so, why is that? What special quality do you like in their work or personalities?
There was emotion in every thread of his songs – it touched you in your heart – something I have only felt with a few singing artists in my life.
-Could we feature your favorite musician, author, artist, designer, architect, filmmaker, etc. in our magazine and/or online?
Yes, if appropriate.
-In which way do you think a profession in health care, art and design are different and/or similar?
Whilst studying in Oxford, I was told that medicine is an art. Indeed, all their science degrees were awarded as Bachelor of Art! It was a little odd, but in retrospect I can understand. The fluid nature of the relationship between an individual and his doctor is a special one in which one can sometimes find the best of humanity. Sometime, many times, the worst can also be found if you look hard enough. Perhaps, those in art and design try to also reflect the spectrum of humanity in their work.
-Did or do you follow any philosophical or psychological approach in your profession?
As a student in Oxford, I studied the works of William Osler, who was a previous Regius Professor of medicine there, well before my time. He made his mark around the world and was regarded as the founder of modern medicine. His writings seemed to be wonderful pieces of prose with almost every sentence a philosophical approach to the practice of medicine. One of my favorites stated that "Medicine is a science of uncertainty and an art of probability."
-What is your favorite building in the world? (If more than one, please list more, and if you like, please tell us why it is your favorite.)
The Blue Mosque in Istanbul holds a special place in my heart. I took my wife there before we were married and in the park between the Blue Mosque and the Hajia Sofia proposed to her. The whole area sits at the cross-roads of civilization and the two buildings complement each other, almost call out to each other in an extraordinarily humbling way.
-What is your favorite hotel? (If more than one, please list more, and if you like, please tell us why it is your favorite.)
The Laguna Beach resort in the Maldives – we spent a very belated honeymoon there. We would love to go back.
-What would be your ideal home? (If more than one, please list more, and if you like, please tell us why it is ideal.)
Decades ago, my father built a house in Bangladesh which still stands to this day. Although made well of solid construction, he gave the project to a local builder who was just starting off. The randomness of its architecture, it’s lack of privacy and complete lack of hallways and for that matter enough space for us as a family make it inconvenient to live in for more than a couple of weeks. Yet, the historical bond that we form with it every time we go makes it a special place. It is the house my father built – and now that he is no longer with us, we allow it to bring us closer to his memories and respect his work. I don’t think anything can be more ideal than that.
-Do you have any dreams for the future?
I, like many, will have dreams for my family but on a more professional level I would like to see our current work reach fruition. By that I mean I would like to see it proven to work, accepted by our peers and for men with prostate cancer to benefit from treatments that carry less harm. It has been somewhat a long road, but I do see a positive end to it.