Hundreds of Swansea Bay men involved in game-changing prostate cancer treatment trial

Treatments for men with prostate cancer have been revolutionised following a worldwide trial involving hundreds of Swansea Bay patients.

Now an expert team at Singleton Hospital is getting ready to go again when a follow-up trial launches later this year.

This one will assess the effectiveness of multiple new interventions including a cutting-edge form of radiotherapy.

(Main image above shows, l-r, research facilitator Nicola Lemon, research nurse Maria Johnstone, consultant in medical oncology Dr Wael Mohamed, research nurse Leanne Quinn and registered nurse Rhian Davies. Also involved were research nurses Dawn Lewis and Rhian Bowen)

March is Prostate Cancer Awareness Month. The disease accounts for a fifth of all male cancers. In the UK there are around 47,000 new cases and 11,000 deaths every year.

It is the most prevalent of cancers in Swansea Bay. The good news is that survival rates in Swansea and Neath Port Talbot, as in Wales as a whole, have seen an improvement, albeit a slow one, over the last 20 years.

An international trial called Stampede began in 2005 with the aim of providing evidence of the best ways of treating men with newly diagnosed advanced prostate cancer.

The largest study of its kind, it recruited almost 12,000 men globally by the time it closed in 2023. It looked at whether adding a range of different treatments to standard hormone therapy resulted in benefits.

It found that some of those treatments improved overall survival for men whose prostate cancer had spread or had a high risk of spread – changing the standard of care around the world.

Swansea Bay, through its Cancer Institute at Singleton, was an active participant in Stampede and won an award for recruiting close to 300 patients – the sixth highest number in the UK.

Among them was Tony Hesslegrave from Sardis, near Saundersfoot, who was diagnosed with prostate cancer in 2013 and is on lifelong medication.

Mr Hesslegrave (pictured) has a hormone therapy injection from his GP every 12 weeks, which is the standard care. However, through Stampede, he also receives an additional drug, Abiraterone, and another medication called prednisolone, with is routinely prescribed alongside it.

“I’m 82 and I think I’m pretty good for my age,” said Mr Hesslegrave, who trained as an engineer and then ran a guest house with wife Christine before they both retired.

“I still do a bit of walking. Not as much as I used to, but that’s not because of the cancer.

“I’m glad I took part in this trial. Not only for myself but to help prove that Abiraterone works, and that hopefully other men will be able to use it and help them along.

“Around the same time I started on the trial, I joined Tenby Male Voice Choir and I’m still with them, which is good.

“I know other people there who have had prostate cancer, and I always pass the word around to say – get it treated.”

The Cancer Institute was involved in several arms of the Stampede trial. Each arm focused on a different treatment, including chemotherapy, new hormonal agents and radiotherapy.

Dr Wael Mohamed, a consultant in medical oncology based at Singleton Hospital, said: “With radiotherapy, in theory we are treating the cancer only when it is limited to the prostate. We are not using radiotherapy to treat cancer outside the prostate – in theory.

“But Stampede showed us that treating the prostate where the patient has limited metastasis elsewhere – up to three metastatic lesions outside the prostate – will help control the disease in the prostate, decrease symptoms and improve the outcome in total, including life expectancy.”

Later this year, a follow-up trial – Stampede 2 – will begin recruiting, and Swansea is already confirmed in the radiotherapy arm.

This will see an advancement on the work undertaken during Stampede, using an advanced technique Stereo Ablative Radiotherapy, or SABR.

Although limited to small number of UK centres, it has been available in Singleton since 2022 thanks to advances in radiotherapy there.

Dr Mohamed said: “During Stampede we gave radiotherapy to the prostate only for patients with metastatic disease.

“Now we want to give radiotherapy to other areas outside the prostate, if there is a limited number. It’s to try to give radiotherapy to multiple areas at the same time, to control the disease in all those areas.

“SABR involves high doses of radiation more precisely targeted. It is more precise to small volume areas, with less impact on other sites. It is all concentrated in one point.

“In this case we are talking about giving radiation to the metastatic area too. It has not been done in this way before, so the trial will show whether there is a real benefit.

“It’s possible we will take part in other arms as they come up, but SABR is the starting point for us for Stampede 2.”

The Cancer Institute was built following a £1 million charity appeal run in conjunction with the South Wales Evening Post, leading up to the opening of the South West Wales Cancer Centre (SWWCC) in 2004.

The SWWCC provides the infrastructure for the Institute’s research delivery team, together with cancer and haematology clinicians, to run various UK and global trials.

Last year, the Institute moved to its purpose-built new home, a dedicated clinical trials suite alongside the Chemotherapy Day Unit on Ward 9 at Singleton Hospital.

Funding from the Welsh Government, first via the Wales Cancer Research Network and now by Health and Care Research Wales, has supported the growth of cancer research within the health board where up to as many as 30 trials can be running at any one time. 

Dr Nicola Williams, National Director of Support and Delivery at Health and Care Research Wales, said: “We're grateful for patients from across Swansea Bay University Health Board participating in the STAMPEDE trial, and the work of the team at Singleton Hospital in taking forward the next stage of the trial which complements the significant amount of research work already underway into prostate cancer diagnostics and treatments.”