Potential game changer in the management of high-risk prostate cancer

Dr Renu Eapen, a Melbourne-based urologist, has used the Royal Australasian College of Surgeons (RACS) Paul Mackay Bolton Scholarship to explore treatment options for men diagnosed with prostate cancer.

Dr Eapen’s research has the potential to change the management of highrisk prostate cancer. It focuses on the clinical and immune landscape response to Lutetium PSMA therapy in advanced disease.

Dr Renu Eapen

High-risk localised prostate cancer is usually treated by radical prostatectomy or radiotherapy. A significant number of these patients will progress to have local recurrence or metastatic disease. Clinical trials of neoadjuvant therapies including chemotherapy have not shown survival advantages.

Dr Eapen is looking at the clinical effects of the novel treatment Lutetium PSMA given upfront before prostate cancer surgery, through the LuTectomy trial. She wants to see how this impacts disease recurrence and long-term survival.

Excitingly, her team can interrogate tissue in the lab and understand the impact of Lutetium PSMA on the tumour microenvironment, including changes in tumour immune context and cell types. Dr Eapen hopes to identify tissue and serum biomarkers that may be associated with clinical outcomes and the factors that lead to the progression of low-risk to advanced disease.

After her urology training, Dr Eapen embarked on fellowships in the US and Canada where she spent four years training in uro-oncology and robotics, as well as functional urology. She was exposed to a great deal of prostate cancer research in highly academic centres, such as the University of California in San Francisco, which sparked her interest in the management of low-risk and highrisk disease.

After returning to Melbourne, through her work at the Peter MacCallum Cancer Centre and Austin Health, Dr Eapen found herself working with teams who were on the cutting edge of incredible research. The collaboration of urologists, nuclear medicine physicians, and medical and radiation oncologists in developing world-class trials led her to enrol in a PhD with the University of Melbourne.

The Paul Mackay Bolton Scholarship is supporting her prostate cancer research based on the LuTectomy trial and her PhD. Dr Eapen and her team will recruit 20 patients for the trial. Seven have been recruited so far.

The outcomes of the trial could potentially be game-changing in the management of high-risk prostate cancer. PSMA technology has changed the landscape in the management of prostate cancer, with significant implications in diagnosis, staging and theranostics. This use of theranostics in high-risk localised prostate cancer is pushing the boundaries even further.

Dr Eapen says the Paul Mackay Bolton Scholarship has been instrumental in backing this important work in prostate cancer.

“Research is exciting if you can imagine the implications of your findings and how they can impact on the day-to-day management of patients,” she said. This potential ‘bench to bedside’ transition is what inspires Dr Eapen and makes her efforts worthwhile. She encourages young surgeons not to accept clinical limitations and to always think about how the situation can be made better for the patient. “This inspires ideas and the RACS scholarships are instrumental at making those ideas a reality.”