NOTES OF MSPCSG MEETING 12  MARCH 2026




Chairman, Ray Monk, welcomed attendees and gave housekeeping instructions for the building following which he introduced Dr. Claire Thompson, Guest Speaker, from Royal Marsden.

Presentation by Dr Claire Thompson:

Prostate Cancer Clinical Trials Overview

Claire introduced herself as a Research Fellow at the Royal Marsden working on radiotherapy trials for advanced prostate cancer. She explained her background in oncology training and current research focusing on Prostate Cancer, including a real-world study called ADAPT involving the drug Apalutamide. Claire added that the slides used in her presentation were provided by a statistician at the ICR and were intended to provide a brief introduction to clinical trials and their purposes.

Claire explained the TRAP and STAR-TRAP clinical trials, which investigate the use of stereotactic body radiotherapy (SBRT) in hormone-sensitive and hormone-resistant metastatic prostate cancer settings. She detailed how these targeted radiotherapy approaches aim to delay disease progression and allow patients to continue their current treatments longer. Her presentation covered the evolution of radiotherapy techniques, the benefits of more precise SBRT treatment, and the role of PSMA PET scans in diagnosis and monitoring. The discussion included questions about prostate cancer types, imaging techniques, and access to different treatments across NHS facilities.

This is the link to Claire’s colleagues YouTube where she shares helpful videos for men with prostate cancer:

https://www.youtube.com/@DrSianCooper

Clinical Trials and Radiotherapy Advances

Claire explained the stages of clinical trials for cancer treatments, emphasising the importance of ensuring safety, effectiveness, and cost-effectiveness within the NHS framework. She detailed the evolution of radiotherapy, highlighting advances in precision and targeting, including the use of CT planning and modern linear accelerators like the MR LinAC at the Marsden. Claire also discussed the shift in prostate cancer radiotherapy from 7.5 weeks to 4 weeks of treatment, as demonstrated by the Chipp trial in the UK, which showed equivalent efficacy and safety.

Advancements in Prostate Radiotherapy

Claire discussed the evolution of prostate radiotherapy, highlighting the shift towards shorter, focused treatments in the UK due to cost-saving efforts within the NHS. He explained the aims of the TRAP and StarTRAP trials, which explore the use of targeted radiotherapy in metastatic prostate cancer to extend the time patients can remain on current treatments before progression. She also described the natural history of metastatic prostate cancer and current treatment approaches, including hormone injections and additional medications like tablets and chemotherapy.

Prostate Cancer Treatment Options

Claire discussed treatment options for hormone-sensitive and hormone-resistant prostate cancer, focusing on the use of androgen receptor pathway inhibitors like Enzalutamide, Apalutamide, Darolutamide, and Abiraterone. She explained that while these drugs are equally effective, treatment selection depends on patient-specific factors such as medical history. Claire also mentioned that hormone injections like Zoladex and new tablets like Relugolex are used as adjunct to standard treatments, with evidence showing that over half of patients survive at least 4-5 years on initial treatment.

Prostate Cancer Radiotherapy Trials Update

Claire concluded her presentation by discussing two clinical trials involving targeted radiotherapy for prostate cancer.

The first trial, TRAP, treated hormone-resistant prostate cancer patients with stereotactic body radiotherapy (SBRT) to specific areas of disease progression, finding it successful in prolonging time before needing new treatment by an average of 2 months with minimal side effects.

The second trial, StarTrap, is a randomised study examining whether SBRT can delay cancer progression in hormone-sensitive patients with either small areas of disease progression or those who have achieved complete or near-complete response to initial treatment. The trial is currently open at 10 UK sites including Marsden, UCLH, and Cambridge, with plans to expand to more centres.

A question and answer session followed.

Update from the Ray Monk, Chair

Ray shared progress on the approval of Abiraterone for non-metastatic locally advanced cancers, highlighting cost reductions and increased accessibility. He also discussed the "man van" initiative, which will provide free PSA tests at a classic car show aiming to raise awareness and facilitate early diagnosis.

The importance of MRI scans and the challenges with current imaging settings was emphasised, whilst also touching on the use of AI in pathology for more accurate cancer detection.The high costs of certain treatments, such as Enzalutamide, was noted, and the potential of immunotherapy in advanced prostate cancer cases. The group also discussed the long waiting times for radiotherapy and the need for alternative treatment centres.

Abiraterone Cancer Treatment Cost Reduction – for use in locally advanced PCa setting

Ray advised on the approval of Abiraterone treatment for non-metastatic locally advanced cancers, noting that it is now significantly cheaper at £2.75 per day due to expired patents and competition from multiple manufacturers. He thanked Joe Woollcott from Prostate Cancer UK for driving this initiative and received acknowledgment from the Department of Health and Social Care.

Free Prostate Cancer Testing Initiative

MSPCSG committee will attend a classic car show on June 14th at Burgess Hill with the “Man Van” where the Prostate Project Team charity will offer free on-site PSA blood tests and home test kits.

Ray discussed a new free testing opportunity for prostate cancer, which does not require bookings but needs an NHS number. He mentioned an agreement with local RH magazines to spread the word about this service. He also highlighted the contrast between the free testing option and private testing, which costs £95, and encouraged others to share information about the free testing to reach those not receiving GP tests.

AI Prostate Cancer Detection System

The development of an AI-powered system for prostate cancer detection using digitised blood slide images was discussed. Ray explained how the unsupervised AI model can help determine cancer presence and severity levels, potentially reducing over-diagnosis and under-diagnosis issues in prostate cancer detection. He expressed hope that this technology would be rolled out to other laboratories and hospitals to improve overall coverage and patient outcomes.

Challenges in Prostate Cancer Diagnosis

The challenges of prostate cancer diagnosis was outlined, focusing on the balance between over-diagnosis and under-diagnosis. It was noted that 24% of biopsies return negative, which he considers too high, and emphasised the importance of MRI scans in improving diagnosis accuracy. Ray also highlighted that PSA levels alone are not definitive indicators, and trends over time, along with factors like family history, play crucial roles in diagnosis.

MRI Scanner Settings Variability

The variability in MRI scanner settings across different manufacturers and equipment types was discussed, noting that approximately 66% of images were satisfactory while 34% were not. Ray explained that scanner settings can vary significantly based on factors like the Tesla strength and coil assembly channels, and emphasised that proper settings depend on the physicist's understanding of the technology rather than the manufacturer. Ray also mentioned his experience working with GE MRI scanners and his recent discussion with Claire about multi-parametric imaging.

Enzalutamide Treatment for Prostate Cancer

Ray advised on a new treatment combination involving Enzalutamide and other drugs for metastatic prostate cancer, particularly for men with germline BRCa mutations also found in breast cancer. He noted that while these treatments are expensive (ranging from £1,655 to £3,000 monthly), NHS prioritises cost-effectiveness while considering patient benefit as primary.

Immunotherapy treatment using a new drug called VIR-5500

Interest was expressed in this particular treatment option. It appears more effective than immunotherapy approaches seen previously.Johann de Bono is leading this research.

Cancer Treatment Innovations and Access

Ray discussed recent developments in cancer treatments, particularly highlighting a promising immunotherapy drug called VIR-5500 that shows potential for late-stage cancer patients.

He also addressed challenges with radiotherapy waiting times, noting an 8-month wait at local centres and the option for patients to travel to other facilities like Maidstone or London. Feedback will be given to Dr. Angus Robinson from this meeting.

Funding announcement by Peter Kyle MP

It has taken 8 months to obtain clarification from this department on the allocation of the £168M new funding for research into Prostate Cancer, with the focus being on AI (artificial intelligence).

Other items

The group discussed HIFU (High Intensity Focused Ultrasound) treatments and MRI scanning techniques, with Ray mentioning upcoming research from Imperial College on prostate cancer treatments. Ray concluded by highlighting the need for national prostate cancer screening programs.

Ray concluded by thanking the attendees and highlighting the importance of continued support and awareness for prostate cancer patients.
NextGroup Meeting

The next MSPCSG meeting will be on 11 June and will feature a presentation from Prof. Charlene Greenwood of Keele University on metastatic prostate cancer research.

19.03.26