What we do
Imperial Prostate is a world-leading team of researcher-practitioners who work towards improving the lives of men who develop or are being investigated for prostate cancer and other prostate diseases.
The group’s mission is to improve the speed, accuracy and safety of prostate disease diagnosis, and to evaluate new treatments which have fewer side effects than standard techniques without losing treatment efficacy. We are dedicated to helping ensure that the best model of prostate disease care is available to all men throughout the UK as well as worldwide.
The group, led by Professor Hashim U. Ahmed, is based at Charing Cross Hospital in Fulham, London, where clinical trials take place in addition to other sites in West London. We are partnered with scientists at Imperial College, who help us develop our research based on the latest scientific discoveries, techniques and technology.
You will find on this web page details for our current ongoing research, ways to get involved and contact details for our management team.
Research & Activity
- Evaluating New Technology
The potential of speedy, accurate and safe prostate diagnostics has been transformed by the development of multi-parametric MRI, the use of which has been pioneered by Professor Ahmed. The benefits of an image-based approach to prostate disease have now been proven by this work – the research group now works to push the limits of this technology even further, to further improve diagnosis of prostate disease while reducing the number of surgical operations and hospital visits for patients.
New technologies are constantly being developed for treating prostate cancer and other prostate diseases, and through partner NHS institutions we trial and evaluate these devices and technologies, such as High Intensity Focused Ultrasound (HIFU) treatment for prostate cancer, or injected water vapour (Rezūm) treatment for benign prostatic enlargement. This work is essential in order to provide evidence that they are safe and effective, and the data collected helps to determine which treatment is best in which circumstance, helping treatment be tailored to the individual patient.
- Education for Urologists
While medical research is essential for driving change for patients, so also is educating practitioners on these changes. Our team is committed to organising and producing masterclasses, seminars and other educational events which allow for information on best practice to disseminate across the whole UK, as well as provide a space for researchers and developers of cutting edge techniques collaborate and discuss the current prostate research paradigm.
We recently successfully ran the Prostate Imaging & Focal Therapy Masterclass 2018. Get in touch with us to hear about upcoming and future events.
- Transforming Standard of Care
Another determining factor in delivering theoretical developments into real advances for patients is reliant on local hospitals having the material means and the knowledge from other successful hospitals to enact change in their unit.
We are running trials on new patient pathways and other organisational structures for hospital administrations to serve as a model of all-UK and worldwide hospitals, such as the RAPID clinic, so that every man having their prostate’s health checked can have the highest quality investigation in the minimum number of hospital trips and time spent waiting.
Summary of current research
PROSTAGRAM – The PROSTAGRAM Trial aims to find an imaging technique, like mammograms for breast cancer, would be offered as a screening test for prostate cancer. For the first time, mortality rates from prostate cancer have surpassed breast cancer which benefits from a screening programme offered to all women.
At present, there is no nationally approved population-based screening programme for prostate cancer. The most common test, prostate-specific antigen (PSA), is too unreliable for screening and it is not recommended for routine use in national screening guidelines. Yet the mortality rates for prostate cancer remain high, with 1 in 24 men dying from the disease.
Recent advances in prostate imaging have led to the development of new techniques which could be offered as screening tests. These new imaging tests are non-invasive, efficient and reliable. The tests which will be included in the PROSTAGRAM trial are:
1. A ‘fast’ bi-parametric MRI. Less than 15 mins scanning time
2. Ultrasound shearwave elastography (SWE). This measures the stiffness of the prostate and is cheaper than an MRI scan
3. Standard of care PSA test
The trial addresses an unmet need for research into alternative screening tests to PSA. It will be the first trial offering men a screening test with MRI and US. It is the first step towards developing a national screening programme for prostate cancer. (Mr David Eldred-Evans)
ATLANTA – The ATLANTA Trial aims to investigate the role of treating the local prostate tumour and metastasis in men with newly diagnosed metastatic prostate cancer. Men with advanced prostate cancer that has spread well beyond the gland itself (metastatic) are currently treated with drug therapy alone, such as chemotherapy. However, there is growing evidence that some men may benefit from having their local prostate tumour treated, even though it has already spread. In addition, some men may benefit from having selected distant cancer deposits treated.
ATLANTA will randomise men to two additional local treatment options Radical treatment (Surgery or Radiotherapy) OR Minimally Invasive Ablative Therapy (Prostate Cryotherapy or HIFU). In addition, some men in these treatment arms will receive specialised radiotherapy to cancer deposits, known as Stereotactic Ablative Radiotherapy (SABR). This is sometimes referred to by brand names such as Cyberknife© radiotherapy. All trial treatments will be in addition to the routine NHS standard of care treatment.
Men in the treatment arms will be compared to men who are undergoing routine NHS standard of care in the control arm. The trial will recruit for two years (April 2019 onwards), with a follow-up period of two years. We will be primarily looking at whether these additional treatments delay the progression of the disease and secondly, whether overall survival is improved.
ATLANTA is entirely charity-funded by the Wellcome Trust. The trial is available in 30 trial centres across the NHS in England & Wales. No man will be more than 30 minutes from an ATLANTA trial centre. (Mr Martin J. Connor)
PROSPECT – Traditionally, level one evidence is obtained from two-arm, or 3-arm, randomised controlled trials (RCT) of a new treatment(s) and compare it to an established treatment in which neither the patient nor the doctor knows who is taking what, until the end of the study (‘double-blind’). Unfortunately, in trials involving surgery or complex interventions, a variety of factors can lead to the failure to accrue sufficient participants in many traditional RCT designs. This has been particularly highlighted in localized prostate cancer RCTs, where 12 RCTs evaluating different interventions in localised prostate have failed to recruit, many in the last 5 years.
IP3-PROSPECT will explore a trial design called the cohort-multiple RCT (cmRCT). This design has been used in a number of disease areas, both benign and cancer. We have chosen prostate conditions since they are extremely common and if malignancy occurs the majority of men with the disease are regarded as living with a chronic condition due to its long natural history and in which innovative approaches, interventions, treatments or changes in management might have a significant patient benefit and impact on the NHS.
We want to test the acceptability and feasibility of the cmRCT in the prostate pathway. As this is the first time that we are trying out this method we need to first pilot it. In the first part of the study, we want to evaluate the following. What is the accrual rate? What do patients and their healthcare professionals think of the cmRCT design? Is the data we collect robust? What are the resource requirements of such a study? We will then test a number of novel interventions or changes in the pathway and compared them to standard care in the cohort that we recruit
CHRONOS – Focal ablative therapy for localised clinically significant prostate cancer is an emerging treatment modality due to the improved post-procedural morbidity rates, and promising short-medium term cancer control outcomes. Though available on the NHS in limited centres, it is not readily available to all patients. The reason for this is the lack of high-quality trial-based evidence comparing focal therapies against radical whole gland treatments. Attempts of randomised control trials have been unsuccessful, primarily due to lack of acceptance of randomisation treatment allocation, and lack of physician equipoise. The unique structure of CHRONOS using side by side RCTs allow patient preference and physician equipoise to be considered will ensure maximal recruitment and retention of eligible patients.
CHRONOS A will directly compare radical therapies to focal therapies, the aim of which is to directly assess both cancer control and functional outcomes of radical therapies to focal therapy. CHRONOS B will compare focal therapy, to focal therapy with neoadjuvant treatment, the aim of which is to improve the re-do rates observed in previous studies.
HEAT and ICE Registry
Focal therapy is permissible per NICE IPG 423 and 424 guidance outside of trial settings provided outcomes are documented within a registry (1, 2). Within the UK, centres providing focal therapy for prostate cancer record oncological and safety outcomes within anonymised multi-centre registries called HIFU Evaluation and Assessment of Treatment (HEAT) and ICE (cryotherapy). These registries rely on charity funding, not corporations or industry partners therefore have no bias towards outcomes recorded.
Currently, 10 HIFU and 8 cryotherapy sites have inputted thousands of focal ablative cases into the HEAT and ICE registries respectively, allowing collaborative research evaluating treatment outcomes- most recently allowing the publication of a comparison between focal therapy against radical prostatectomy for localised prostate cancer (3). Such collaborative evaluations are important for assessing local outcomes to the UK average, as well as determining areas of improved treatment delivery and enabling providers to better counsel patients pre-operatively (4-7).
- Excellence NIfHaC. Focal therapy using cryoablation for localised prostate cancer: IPG 423. 2012.
- Excellence NIfHaC. Focal therapy using high-intensity focused ultrasound for localised prostate cancer. In: Excellence NIfHaC, editor. 2012.
- Taimur T Shah DR, Max Peters, Daniel Ball, Na Hyun Kim, Enrique Gomez Gomez, Saiful Miah, David Eldred- Evans, Stephanie Guillaumier, Peter S.N. van Rossum, Marieke J van Son, Feargus Hosking- Jervis, Time Dudderidge, Richard Hindley, Amr Emara, Stuart McCracken, Damian Greene, Raj Nigam, Neil McCartan, Massimo Valerio, Suks Minhas, Naveed Afzal, Henry Lewi, Chris Ogden, Raj Persad, Jaspal Virdi, Caroline M. Moore, Manit Arya, Mark Emberton, Hashim U. Ahmed, Mathias Winkler. Focal therapy compared to radical prostatectomy for non-metastatic prostate cancer: a propensity score- matched study. Prostate Cancer Prostatic Dis. 2020.
- Guillaumier S, Peters M, Arya M, Afzal N, Charman S, Dudderidge T, et al. A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer. Eur Urol. 2018;74(4):422-9.
- Shah TT, Peters M, Eldred-Evans D, Miah S, Yap T, Faure-Walker NA, et al. Early-Medium-Term Outcomes of Primary Focal Cryotherapy to Treat Nonmetastatic Clinically Significant Prostate Cancer from a Prospective Multicentre Registry. Eur Urol. 2019;76(1):98-105.
- Lovegrove CE, Peters M, Guillaumier S, Arya M, Afzal N, Dudderidge T, et al. Evaluation of functional outcomes after a second focal high-intensity focused ultrasonography (HIFU) procedure in men with primary localized, non-metastatic prostate cancer: results from the HIFU Evaluation and Assessment of Treatment (HEAT) registry. BJU Int. 2020;125(6):853-60.
- Huber PM, Afzal N, Arya M, Boxler S, Dudderidge T, Emberton M, et al. Focal HIFU therapy for anterior compared to posterior prostate cancer lesions. World J Urol. 2020.
Professor Hashim Ahmed
Professor Hashim Ahmed
Chair in Urology (Clinical)
Deputy Operations Manager
Clinical Trial Administrator
Clinical Project Manager
Clinical Trial Practitioner
Clinical Trial Practitioner