Jonathan Simons MD, President and CEO, Prostate Cancer Foundation
With more than 27 varieties of the disease, prostate cancer has long been difficult to diagnose and treat, but research funded by the Prostate Cancer Foundation is making exciting discoveries that are changing diagnosis and care for patients. President and CEO Jonathan Simons MD outlines some of the key breakthroughs in understanding of the disease, and why the organisation’s ultimate goal is to put itself out of business
Could you begin by providing a brief overview of the Prostate Cancer Foundation (PCF)?
We were founded in 1993 and our primary focus is to support research to find cures for the 27 known types of prostate cancer. We follow what we call a venture philanthropy model for cancer research, funding high-risk, high-reward projects as well as Young Investigators to ensure there is a pipeline of talented, innovative minds working on new diagnostic and therapeutic tools. We offer two-year Creativity Awards for exceptional projects with the potential for breakthroughs, and extended three-year Challenge Awards for cross-disciplinary teams.
The Foundation is unique in that it is active, not passive. We are a global organisation which funds research in 12 countries, and staff here actively seek novel ideas to fund to reduce death and suffering from prostate cancer. We are constantly looking for more researchers all over the world. In fact, we are not really a funder; our role is to identify where investments should go and steward the deliverables of those investments with an eye to delivering results.
As an MD, President and CEO of the PCF, you have a responsibility towards the continued pursuit of prostate cancer research, education and dissemination. How do you manage these responsibilities whilst advising all stakeholders involved?
The idea is to use education and dissemination to push the research, with the ultimate goal being to put the Foundation out of business.
Our aim is to understand the current state of prostate cancer research, re-evaluate it, talk to researchers and patients participating in the research, and disseminate the findings via print, online and other media resources. We communicate to seven key audiences. The primary, most important audience is patients. The second is the scientific community. We run the world’s largest and most admired research retreat each year, and the only requirement is that scientists share their unpublished data. Thirdly, we try to accurately but neutrally communicate findings with the biotech and pharmaceutical industries. Number four on the list is disseminating the work undertaken in universities to industry. Five – we periodically update the national funders and the large stakeholders in the US, including the National Institutes of Health (NIH) on research developments, which are picked up by the decision makers through federal funding. Six – we inform clinicians, such as urologists, radiation oncologists, medical oncologist, etc. by holding meetings between young and senior clinicians and sharing new research findings, particularly those from a laboratory. Finally, we talk to the lay media where appropriate.
On a more personal level, our Senior Vice President of Communications, Dan Zenka, has his own cancer blog (www.mynewyorkminute.org) through which he reaches out to patients and families. He was diagnosed with aggressive prostate cancer at the age of 51, two years after joining PCF.
Since the establishment of PCF, how has it contributed to the study of prostate cancer?
PCF funded the research that defined the 27 types of prostate cancer from aggressive to non-life threatening forms of the disease. So, the Foundation has identified a Rosetta Stone code, translating or outlining the genetic codes, for the numerous kinds of prostate cancer. The second big contribution PCF has made is opening up research into immunotherapy. We have several newly approved drugs that are able to ‘turn on’ the immune system to prostate cancer.
The Foundation has also opened doors for a whole new generation of cancer vaccines and cancer antibodies for the top four cancers: colon, breast, prostate, and pancreatic. In addition, a few weeks ago we have seen our fifth approved drug for advanced metastatic disease, which is a biotech and pharmaceutical study initiated at university level through funding by us.
This Foundation has pushed more new drugs to global approval in the last 10 years than any other biomedical, intensive funding organisation for any disease.
What has been the greatest driver at PCF in the pursuit of a cure?
The Foundation comprises like-minded people who believe that working for a non-profit organisation makes the science go faster. I am part of a large team that really wants to cure prostate cancer. Thanks to the Rosetta Stone code, we are very optimistic because we are looking at treating a subset of 20 or so diseases. The driver for us now is not a dream that prostate cancer is curable; it is the scientific fact that it is.
We know that we need more new effective drugs, and that there is a need for better diagnostic tests. We know we should be working harder to prevent the disease in men in their 20s and 30s, but the fact is we have turned a corner in terms of curability in the advanced stage. That has happened in the last three to four years, and this is the biggest driver – we can see the end to mortality from this disease.
Why is prostate cancer a growing risk amongst men and what makes them more susceptible?
Prostate cancer was not a prevalent problem at the turn of the 20th Century because no one lived to the age of 60. We still don’t fully understand the causes of prostate cancer. We know that men in their 20s and 30s who are more susceptible to the disease experience a chemical change in the prostate that allows the cancer cells to mutate in their DNA. We know that some families are more at risk because they inherit genes which stop cells from being able to repair or proofread errors made in the DNA.
We believe that nutrition makes a huge difference. There are certain diets that are more inflammatory, in that they are similar to pouring gasoline on an ember that might be starting to burn. However, we still have a lot of work to do to understand the mechanisms behind these 27 types of prostate cancer. Actually, this disease is rising rapidly in China now, and PCF has launched a new research initiative, partnering with the Chinese Urological Association, in an effort to promote and fund prostate cancer studies in the country.
The aim of the China initiative is to understand the research behind the spike in Chinese-related prostate cancer diagnoses, including the development of treatments or therapies that includes traditional Chinese medicine with western techniques to treat the disease. We are also working closely with the Beijing Genomic Institute (www.genomics.cn) to understand the genomics behind a prostate cancer diagnosis.
What are the current limitations of diagnosis and subsequent treatment?
There are a number of limitations, the first being that we are now talking about 27 prostate cancer diseases so you need tests for 27, not for one. To do that you need to know exactly what makes each one of those diseases tick, and we are currently working on the genomics to do this.
Secondly, prostate cancer is very sneaky – it evolves over decades and there is very little residue from a prostate cancer cell in the beginning. There are only two places these cells can go: either into the bloodstream or through the urethra into the urine. We still have a lot of work to do to be able to detect a single cancer cell in a drop of blood or in urine. There is imaging technology currently being developed in San Diego in the US that is like being able to pick individuals out from a crowd of say 60,000, and this is being applied to prostate cancer research. However, searching for a few cancer cells among millions still presents a huge, technical issue.
Thirdly, we have a global shortage of men with prostate cancer volunteering to have their cancers biopsied again once the tumours become resistant to the current new medicines. We do not have an ethos of duty to help others, and we are going to have to change that culture. This means doctors strongly recommending that patients come back for further biopsies on cancers that have returned. This is how we cured testicular cancer and leukaemia, and this is now the paradigm for curable lymphoma.
What resources and support system do you provide to the sufferers and their families in order to cope with the disease? How do you communicate an early warning system as to target prevention?
Our focus is to support research and to disseminate the latest medical information. We have a guide for patients with prostate cancer on our website, and we constantly update online materials.
In terms of early detection and screening, we are funding research, ahead of others, on better urine tests for prostate cancer because current tests are around 10-15 years old. But it is the role of the NIH to implement those tests in the public health system. In the US, there are a number of very good support networks for people with cancer, such as the American Cancer Society.
Finally, could you highlight some of the latest developments that you are excited about?
We have two ‘dream teams’ of 60 scientists: one is composed of British, Canadian, and American investigators, while the other comprises Canadians and Americans. Both of these are $10 million efforts, funded by PCF – with generous support from Movember – and Stand Up to Cancer and coordinated with help from the American Association of Cancer Research. The goal is to bring forward nine to 10 new drugs in the next four years by biopsying 500 men with advanced prostate cancer. We are filing the data, looking for a cure and matching experimental drugs to the cancer these 500 men have. This is called precision medicine. This is very exciting because the scale and potential is so great, and the speed at which the findings can go to the major hospitals via the Internet is unprecedented. We are very excited about these global collaborations.
The last thing I would say is that we have preliminary data on a treatment strategy for an incurable form of prostate cancer. This new adjuvant combination therapy comes from a project we funded at Harvard University, which was presented at the American Society of Clinical Oncology in Chicago, and it is a combination of a new experimental drug that has been approved. We now need to fast-forward to confirm its effectiveness and curability. We are using the word ‘cure’ not to raise money but to advance the entire scientific research community in this field.