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(MCRC Clinical - Leeds-Manchester) Personalising re-irradiation of locally recurrent prostate cancer directed by MR imaging and hypoxia biomarkers

Project Description

External beam radiotherapy (EBRT) is the most commonly used primary treatment for men with non-metastatic prostate cancer. Outcomes are generally good but 20-50% of patients will develop recurrent disease within 10 years. A proportion of patients will have isolated recurrence within the prostate, usually at the site of the initial dominant intra-prostatic lesion (DiL) seen on multi-parametric MRI (mp-MRI).

Re-irradiation, using EBRT or brachytherapy (BT), can be used as salvage treatment but uncertainty about safety and optimal patient selection has limited utilisation. Multiple retrospective series and limited prospective non-randomised trials have demonstrated that re-irradiation can be delivered relatively safely with a second biochemical recurrence free survival rate of approximately 50% at 3 years.

Re-irradiation research to date has focused on patients with good prognosis disease who are often unlikely to die from prostate cancer. Little evidence is available in those with high-risk or castrate resistant local recurrence. These patients are at significant risk of death from prostate cancer and have limited systemic treatments options whilst disease is non-metastatic.

Evidence now exists to support an overall survival benefit with prostate EBRT in men who present initially with limited hormone sensitive metastatic disease demonstrating that the progression of metastatic disease can be tempered by treatment to the primary prostate cancer. Pre-clinical data also suggests that radiation to locally recurrent prostate cancer can prevent further metastases, often termed the “second wave” of metastatic disease.

Now robust evidence exists that treating primary disease upfront in the metastatic setting provides a survival advantage, will this also apply to those with high risk and/or castrate resistant locally recurrent prostate cancer?

This project will investigate optimal imaging and patient factors to select candidates for re-irradiation and develop imaging and RT delivery techniques that can then be tested in pilot study in small cohort of patients.

Entry Requirements:
Candidates must hold, or be about to obtain, a minimum upper second class (or equivalent) undergraduate degree in a relevant subject. A related master’s degree would be an advantage. All applicants should be post-registration clinicians and ideally have a specialist training post. Candidates of any nationality may apply but must have been resident and working in the EEA (European Economic Area) for three years immediately before application and intend to pursue a medical career in the UK.

To submit a formal application for this studentship please make direct contact with Jo Bentley, Clinical Academic Training Programme Manager

Funding Notes

The clinical fellowships are tenable for three years. We will provide running expenses, an appropriate salary in line with the applicant’s current salary and grade, and full coverage of University PhD fees. Where international student fees are payable, please provide evidence with your application of how the shortfall will be covered (approximately £19,000 per annum).

As an equal opportunities institution we welcome applicants from all sections of the community regardless of gender, ethnicity, disability, sexual orientation and transgender status. All appointments are made on merit.

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