Deepika Reddy1, Jin Ye Yeo2
1Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; 2TAU Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. TAU Editorial Office, AME Publishing Company. Email: tau@amepc.org
Expert introduction
Following completion of her MBBS at Imperial College London, Dr. Reddy (Figure 1) entered higher surgical training in Urology in London. She has developed a specialty interest in the diagnosis and treatment of prostate cancer. Having returned to Imperial, Dr. Reddy was awarded a PhD in 2023, evaluating the outcomes of focal therapy for the primary treatment of prostate cancer. Her work included multi-center national evaluation and comparison of focal therapy outcomes against radical treatment. During this time, she coordinated the approval and opening of IP4-CHRONOS trial investigating the feasibility of recruiting to a randomized control pilot trial assessing the outcomes of radical treatment and focal therapy with/without the use of neoadjuvant treatment for localized prostate cancer. This is where she developed her passion for improving patient outcomes with the use of evidence- based- medicine to optimize shared-decision making and reduce treatment regret.
Since her PhD she has taken time out of clinical training to pursue a Fulbright Scholarship, tailored toward evaluating outcomes of patients treated in multiple centers across the USA. Following the scholarship, Dr. Reddy will return to her final year of residency training and Guys and St Thomas’s, London and hopes to complete a fellowship in focal therapy treatment.
Figure 1 Dr. Deepika Reddy
Interview
TAU: What drove you into the field of urology, particularly in the area of prostate cancer diagnosis and treatment?
Dr. Reddy: Urology and specifically prostate cancer are rapidly evolving fields of clinical practice. Massive efforts have been put in to understand which patients benefit from treatment and better balance disease management with quality of life, which is where my true passion lies. The management of urological conditions often allows the development of relationships not just with patients but with various members of the multi-disciplinary team and other specialties, enabling holistic and thoughtful care of patients and their disease.
TAU: Could you provide an overview of the recent publications in focal therapy for prostate cancer? Are there any recent new findings that intrigued you?
Dr. Reddy: Evidence surrounding focal therapy for prostate cancer is rapidly emerging. Increased understanding of the pathological process and technology behind focal therapy has led to very promising publications. Highlights for me include the consensus “FALCON” statement led by Dr. Rodriguez Sanchez (1), a succinct letter reporting upon common concerns on patient selection, general treatment techniques, and follow-up. This publication demonstrates expert agreement which may be referenced by all clinicians involved in the treatment and follow-up of patients with prostate cancer. Further, Mattlet et al. externally validated a definition of prostate-specific antigen (PSA) kinetics indicating focal therapy failure first reported by Huber et al (2). A major benefit of focal therapy is the preserved quality of life; however, the stringent follow-up protocol can lead to significant anxiety for patients. The ability to tailor which patients require post-treatment multiparametric magnetic resonance imaging (mpMRI) and biopsy and which may be safely spared such investigations by using PSA-based follow-up has the potential to improve the balance of oncological control and impact upon quality of life further. There are numerous further publications of note in this rapidly expanding field of treatment and study, including the use of Artificial Intelligence, Machine Learning, and enhanced methods of post-treatment imaging reporting—the list is endless!
TAU: Focal therapy for prostate cancer is currently not widely available in the National Health Service (NHS). In your opinion, what are some barriers that are limiting the availability of focal therapy?
Dr. Reddy: Aside from the typical hurdles with setting up any service, extra nuance and understanding of the treatment is required from not just the surgical team, but also from many other members of the multi-disciplinary team. The success of focal therapy is based on precise diagnostics, treatment, and follow-up. Close working relationships with pathology, radiology, oncology and nursing specialists are vital. Setting up a successful and efficient service also requires buy-in from surrounding centers willing to refer potential patients This may be hindered due to the lack of widespread understanding of focal therapy, its aims, and outcomes. This knowledge gap can be explained by National Institute for Health and Care Excellence (NICE) and European Association for Urology (EAU) approvals, but only with ‘special arrangements’ for clinical governance. Thus, until fully and readily endorsed by governing bodies, justification for wide availability is limited. With emerging medium-term observational data, and trials such as FARP (focal prostate ablation versus radical prostatectomy), PRESERVE (Pivotal study of the NanoKnife® system for the ablation of prostate tissue), PRIS (Prostate Cancer IRE Study), and TACT (TULSA-PRO® Ablation Clinical Trial) due to publish results, I envision these barriers coming down in the not-too-distant future.
TAU: Could you share some projects that you are currently involved in? What goals do you hope to achieve with these projects?
Dr. Reddy: I am honored to have been awarded a Fulbright Scholarship to enable the evaluation of prostate cancer outcomes following focal therapy and radical prostatectomy within the USA. Coordination of multi-center treatments will enable a true reflection of outcomes internationally, provide a better understanding of which patients may benefit most from focal treatment, and inform about how to best tailor follow-up on a patient-specific level.
TAU: In your current/upcoming work involving the multi-institution collaboration to establish outcomes following radical prostatectomy and focal therapy in the USA, could you share how you feel about this collaboration and what are some aspects that you are looking forward to the most?
Dr. Reddy: I am extremely appreciative to the Fulbright Commission, Royal College of Surgeons, and Johns Hopkins University for supporting my work. I hope to use this time to develop a collaborative evaluation of focal therapy for prostate cancer and how it compares to traditional radical prostatectomy with the aim to better determine which patients would benefit from specific treatment modalities. This project has required the development of relationships across multiple internationally renowned institutions and clinicians across the USA, a process I previously never believed possible within my career. Aside from the personal development this project has encouraged, I am excited to lead an evaluation of treatments for prostate cancer that can impact how we treat patients and aim toward improving outcomes.
TAU: In addition to prostate cancer research, you are also passionate about pelvic cancer treatment. In your opinion, what are some significant research gaps in pelvic cancer research?
Dr. Reddy: In general, oncological outcomes have been well-researched and presented. In my opinion, understanding how this relates to how patients perceive their quality-of-life following treatment is vital and an emerging field. I am encouraged by the work my colleagues have done with regard to qualitative outcomes to better understand the trade-offs patients experience during cancer treatment. Examples include that of the COMPARE study specifically evaluating the level of oncological compromise patients with prostate cancer are willing to take for improved post-treatment morbidity (3). Lane et al. reported an analysis of patients recruited to ProtecT, evaluating the quality of life against multiple treatment modalities (4). Outside the field of prostate cancer, Lobo et al. recently reported on the utility of gynaecological organ involvement in patients with muscle-invasive bladder cancer (5). Such work to better understand the impact of treatment provided and the oncological gain is vital to enable shared decision making. Ongoing studies will enable clinicians to better counsel and support patients through treatment.
TAU: As an author and collaborator, what are some goals you hope to achieve with TAU?
Dr. Reddy: I am grateful to have been supported by TAU in my early academic career. The support provided when producing earlier manuscripts has impacted my confidence in scientific writing in areas of interest. I look forward to seeing TAU continue its work with young and established academics alike to inspire new and novel publications to impact the field of both uro-oncology and urology. Having worked with the team at TAU, I have every confidence the journal will continue to grow its influence and impact factor. I would be honored to continue working with the team.
Reference
- Rodríguez-Sánchez L, Reiter R, Rodríguez A, et al. The FocAL therapy CONsensus (FALCON): enhancing partial gland ablation for localised prostate cancer. BJU Int 2024;134(1):50-53.
- Mattlet A, Limani K, Alexandre P, et al. External validation of biochemical recurrence definition to predict oncologic outcomes following focal therapy for localized prostate cancer using high intensity focused ultrasound. Prostate 2023;83(16):1564-1571.
- Watson V, McCartan N, Krucien N, et al. Evaluating the Trade-Offs Men with Localized Prostate Cancer Make between the Risks and Benefits of Treatments: The COMPARE Study. J Urol 2020;204(2):273-280.
- Lane JA, Donovan JL, Young GJ, et al. Functional and quality of life outcomes of localised prostate cancer treatments (Prostate Testing for Cancer and Treatment [ProtecT] study). BJU Int 2022;130(3):370-80.
- Lobo N, Uthayanan L, Uribe-Lewis S, et al. Gynaecological organ involvement in females undergoing radical cystectomy: a multicentre study. BJU Int 2024;133(4):474-479.