Prof David Neal

Better screening and treatment for prostate cancer

Professor David Neal and his colleagues in Cambridge are taking a number of different approaches in their work on prostate cancer. A particular focus for the team is to identify better ways of distinguishing aggressive cancers from “non–aggressive” cancers in order to target surgery to the right group of men.

Prostate cancer screening

Prostate cancer screening currently relies on testing for the presence of a protein called PSA in blood samples. High levels of PSA may indicate prostate cancer, but levels may also be raised for other reasons. So the test is not 100 per cent reliable.

Professor Neal is a Principal Investigator in a study called ProtecT. This NHS-funded trial aims to determine the most effective treatment for early stage prostate cancer - surgery, radiotherapy or active monitoring (so-called ‘watch and wait’). Men have been recruited to the study through PSA screening.

An ‘extension’ to the trial, funded by Cancer Research UK, is now looking to see whether PSA screening helps save lives or whether it can lead to men being treated unnecessarily. This part of the study is gathering data on men who have not been screened to see how many of them develop prostate cancer and whether their outcomes differ from the PSA screened group in the initial ProtecT trial.

These large and long-term studies hope to address some of the uncertainty around using the PSA test to screen for prostate cancer. The trial is also collecting blood samples for future studies of genes and markers of the disease.

Professor Neal’s team is also evaluating a new test for prostate and bladder cancer that measures levels of a protein called MCM5. MCM5 is produced by some cancer cells and can be measured in urine samples. If the test is shown to be effective and accurate, it could change the way that bladder cancer and prostate cancer are detected.

Hormones and growth factors in prostate cancer

The team's work on growth factors and hormones aims to understand why some prostate cancers fail to respond to hormone treatment. Hormone treatment for prostate cancer uses drugs that block the action of testosterone, the male sex hormone, which encourages prostate cancer cells to grow. By studying those tumours that do not respond to such treatment, Professor Neal hopes to discover new ways of treating the disease.

Cancer genetics

Professor Neal is also studying the genes that can go wrong in different cancers, and how these differ from person to person. Using cutting edge technology, his team hopes to determine the precise 'genetic profile' of particular cancer types - including bladder and prostate cancers. This kind of genetic profiling may enable doctors to personalise people's cancer therapy, for example by predicting how aggressive a person's tumour is or which drugs it will respond best to.

ProMPT

Professor Neal chairs ProMPT (Prostate cancer: Mechanisms of Progression and Treatment) - a national coalition for prostate cancer research funded by Cancer Research UK, the Medical Research Council and the Department of Health, which aims to speed up the delivery of new markers and treatments from the laboratory for patients (translational research).

Bladder cancer

Professor Neal is also an investigator on a new trial called BOXIT which aims to determine if a tablet (a COX2 inhibitor) will decrease recurrence of bladder cancer.