Professor Hashim Ahmed is Chair of Urology at Imperial College London (ICL). He specializes in the diagnosis and treatment of prostate diseases, such as cancer and benign prostatic hyperplasia (BPH). He has published over 150 peer-reviewed papers in areas that have led to key changes in the way we diagnose and treat men with localized prostate cancer. Prof. Ahmed is a pioneer of minimally invasive prostate treatment therapies, including high-intensity focused ultrasound (HIFU). We recently spoke with him to learn more about his innovative work.
How did you become interested in HIFU?
My first experience with HIFU was during my PhD studies at University College London (UCL). I had received funding from the Pelican Cancer Foundation, which is a UK-based charity that aims to improve the diagnosis and treatment of pelvic and liver cancers, to conduct the first three focal, transrectal HIFU trials for treating localized prostate cancer. Those trials were formative for me. The difference in recovery and quality of life for HIFU patients versus those who had their prostate removed with surgery or irradiated with radiation was astounding.
What are your funding sources?
Early on, I received most of my funding from small charities who were willing to take risks with a new concept like focal HIFU. The idea of a focal prostate cancer treatment was – and still is – controversial. We needed charities like the Pelican Cancer Foundation and Prostate Cancer UK to help establish proof of concept.
Now, my research budget at ICL is approximately £12 million in total over the last six to seven years. This funding comes from both charitable and government sources, including the Urology Foundation, Prostate Cancer UK, Cancer Research UK, Wellcome Trust, the Focused Ultrasound Foundation, the UK Research and Innovation Medical Research Council, BMA Foundation and the National Institute of Health and Care Research. Additionally, we are deeply grateful for support from philanthropic gifts.
What are your current clinical trials related to focused ultrasound?
We have several clinical trials ongoing investigating prostate cancer from a variety of angles.
- Hormones Plus Focal Therapy: We have just finished a pilot study called IP4-CHRONOS, funded by Prostate Cancer UK to investigate whether men would be willing to be randomly selected to receive either focal HIFU therapy alone or focal therapy plus a hormone beforehand. The theory is that the hormone – taken for just a few weeks before focal therapy – would help devascularize and shrink the tumor, making it easier to ablate within a single focal therapy session. Overall, the initial results were positive, and we are seeking funding for a larger, pivotal study.
- Treating Metastatic Disease: Our current trial, called IP2-ATLANTA, is funded by Wellcome Trust. It is exploring the effect of HIFU or cryotherapy – depending on the tumor – in participants with metastatic prostate cancer who are already undergoing standard of care treatment. We will be assessing whether focal therapy adds additional benefit to the drugs that these patients are normally prescribed (like hormones and chemotherapy).
Tell us about your team.
This work would not be possible without a brilliant team of radiologists, nuclear medicine physicians, pathologists, and the senior nurses and nurse practitioners. On the clinical trial side, there are nursing teams, clinical trial coordinators and operations managers, and statisticians that make sure everything runs smoothly all the way from patient care to the reliability of the final data.
What has been your greatest achievement?
My most significant research to date has been the PROMIS trial, which was a pivotal validation study using MRI to diagnose prostate cancer. My co-principal investigator, Prof. Mark Emberton, and I found that MRI could be used to detect the cancer at a sensitivity of 92%, showing an improvement over transrectal biopsy, the traditional method of diagnosing prostate cancer, which has a diagnostic sensitivity of 48%. We learned that the method for diagnosis that had been used for three decades was really no more accurate than a coin flip. Moreover, we discovered that if a patient had a negative MRI, their chance of having life-threatening prostate cancer was only 5%.
There were three important outcomes from that study. Firstly, tens of thousands of men every year can now avoid an unnecessary biopsy, and secondly, those who do have a biopsy have a much more accurate diagnosis because the area of suspicion has been identified by MRI. Lastly, because we can accurately locate the tumor with MRI, more patients can opt for focal treatments like HIFU.
What is on your research wish list?
One area that I would like to explore is BPH, which is the enlargement of the prostate. It is a crowded market, meaning there are many treatments being developed for the disease, because there is a huge population of men who suffer from BPH. The current standard of care for BPH is a transurethral resection of the prostate – or TURP – procedure, where a physician uses lasers or electrical wire to essentially cut and remove areas of the prostate. The TURP procedure carries up to a 5% risk of incontinence and 10% chance of erectile dysfunction and requires a hospital stay. With HIFU, the risk of incontinence is close to 0%, and the risk of erectile problems is much lower than that of the TURP procedure because the target is in the center of the prostate. HIFU patients also go home the same day. I would like to explore further how HIFU could benefit these patients.
How could the UK Focused Ultrasound Foundation assist your work?
There is a unique mechanism in the UK where charities can be registered with the Association of Medical Research Charities (AMRC). This is important for my work because, if an AMRC organization funds a clinical trial, that trial has access to the National Health Service’s (NHS) infrastructure that supports patient recruitment and follow-up logistics. This support is essentially a government subsidy, but it can account for in-kind support hundreds of thousands and up to £1Million that can include covering the cost of investigational treatments. Without the NHS support, the trial grant will have to sufficiently cover that cost.
What motivates your work?
I am hopeful about the work that we will be able to do now that the UK Focused Ultrasound Foundation is up and running. My patients keep me motivated to advance the best treatments and to push to further establish HIFU as a treatment option for more men.