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Maitland Prostate cancer: from bench to bedside

Rather than take all tissues, we can then decide those case withdrawal of 5-10 mL of venous blood. In our
which are required to be part of each specific scientific experience taking the time, and making personal
study. Prior warning is also important for provision of contact ensures a high participation rate amongst
patient consent as part of our ethical requirements. patients, and their close relatives. The information
provision is key both before and after surgery, and I
In this sense the surgeon is a vital part of the strive to thank all of the contributing patients in any
research team, although he may only feel that he is press releases and in journal paper acknowledgements.
“supplying tissues”. I prefer to refer to a surgeon’s role We are frequently asked on the regular visits to my
as supplying first class tissue biopsies, and such a laboratories by patient support groups, “Could that
procedure is clearly worthy of an authorship on any culture be from ‘my’ prostate cancer”.
scientific publications. The decision making, review
of patient’s details are all essential components Urological histopathology
in a translational study. As with all co-authors, the As discussed earlier in this review, there remains
collaborating surgical team is sent final drafts (before an enormous disconnection between the study of
submission) of relevant academic publications. They prostate cancer in a few cell lines, and the disease in
may claim not to understand all of the science, but real patients, as provided by histopathology analysis
hopefully can pick up on any clinical inaccuracies. prior to surgery: decision making about treatment
options. Where surgery is selected, then the analytical
Lastly and perhaps most often neglected is the role of the pathologist does not end at this point.
retention of strictly limited but anonymised clinical Firstly they must regularly review the post-operative
information about the patients not only prior to the biopsy procedure. Our intention is always to do
first operation, but also over time - longer term clinical nothing to harm the histological analysis, performed
outcomes are essential when working on biomarkers, to confirm the initial biopsy based treatment decision.
for example. Our collaborations have now been in place This secondary analysis can on occasion differ from
for a sufficient time to see the recurrence of tumors the pre-operative one, and for scientific purposes it is
resected during the first periods of tissue collection: really useful to both mark the research biopsy location
enabling longitudinal studies of tumor progression. (using inks) and/or to repair the sample location with a
Trainee surgeon or research nurse compatible glue filler. In both cases further analysis will
Such is the pressure on surgical time, the involvement confirm the precise section of tissue under scientific
of another team member radically boosts the quality study - particularly important in a heterogeneous
(and quantity) of materials supplied to the research tumor such as prostate cancer.
laboratory. There are two strategies possible, both of
which involve the provision of part or full time salary, Pathology also has a further role: to confirm that
eligible to be funded by a scientific research grant. the patient matched “normal” tissue biopsies we
take, when the tumor seems confined and relatively
Translational research has often been the result homogeneous, was indeed from a normal region of the
of the needs of a clinical trainee, who exploits the prostate. For this approach to work, there is a certain
materials in his/her MD or PhD studies. Alternatively, amount of faith and extra effort from the science
funding a dedicated research “nurse” with an NHS or laboratory. On a number of occasions a normal or tumor
University employment contract can provide a service biopsy has turned out to be incorrectly diagnosed, only
by taking postoperative biopsies (guided by the after extensive processing [Figure 2] according to the
consulting histopathologist, see below). This person histopathology analysis. The tissue is then relabeled,
can also handle the shipping of materials in insulated or even removed from the study as unreliable.
packages. We also supply a dedicated refrigerator
adjacent to the Operating Facility, which contains Clinical and medical oncologists
aliquoted transport media. The nurse/trainee liaises Once a prostate cancer patient has relapsed, or has
with both the laboratory and couriers to ensure rapid chosen radiotherapy/brachytherapy, they are treated
transfer for tissue processing. by oncologists. At this point a biopsy (from the patient
rather than a post-operative specimen) is more
Again this team member’s importance goes beyond difficult to justify ethically. However, this is the very
tissue provision. It begins by discussion of the population that we need to understand more - and to
research with the patient, when he is first scheduled for learn how to treat. We are now discovering that the
surgery. This not only involves supplying the required application of chemotherapy/radiotherapy together
information sheets and forms for signature, but also with hormone treatment at an earlier stage in prostate
the time to explain what will happen, including in our cancer disease progression, provides startling
268 Journal of Cancer Metastasis and Treatment ¦ Volume 3 ¦ November 17, 2017