My research and clinical interest is to improve the outcomes of men with prostate cancer through the design and conduct of clinical trials and on the generation of clinical practice guidelines.
Using my formal training and expertise in clinical trial design, conduct and analysis, I have been awarded a number of grants investigating new radiotherapy techniques and hormonal maneuvers. The main thrust of my research was to document the feasibility, tolerability and efficacy of stereotactic ablative radiotherapy (SABR) using standard linear accelerators. Our group is among a few internationally who have been recognized for this paradigm-changing work. Since my last promotion, I am the PI or co-PI on 8 prospective clinical trials: 6 of which have peer-reviewed grants supporting them, 2 of them are randomized controlled trials and one of these is being performed in a multicentre study context.
The foundation of evidence-based medicine is the systematic review and the resultant clinical practice guideline (CPG). The latter is the clinical application of the data on a given topic and is represents the product most likely to represent the truth. As such, these CPGs are widely disseminated and are used for funding decisions and audits of quality of care. Since my last promotion, I have been invited to co-chair both Cancer Care Ontario’s Program in Evidence-Based Care Genitourinary Group and the American Society of Clinical Oncology’s Genitourinary Guidelines Advisory Group. I continue to lead guidelines for the management of androgen-sensitive prostate cancer, management of castrate-resistant prostate cancer and management of malignant spinal cord compression, of which prostate cancer patients are at greatest risk.
Our group has shown that 5 treatments of SABR can be iso-effective and iso-toxic compared to 38 treatments of external beam radiation for low-risk prostate cancer patients. Furthermore, we’ve shown that 33 fewer visits are more convenient for patients, save almost $2,000 in out-of-pocket costs, increase radiotherapy throughput by 7-fold and decrease per patient departmental costs by 80%. As a result, I have been awarded more peer-reviewed funding to further study and refine these approaches, including a national, multicentre, phase 2 randomized study; I have been invited to lead an international consortium on prostate SABR; and I have received various national and international speaking invitations to share our work and vision.
These guidelines have been published in high impact peer-reviewed journals and have led to setting and changing practice standards internationally. The work has been widely cited in top-named journals; I have been invited to speak, join committees and Editorial boards nationally and internationally. Furthermore, I have taken the lead on new questions arising from the work to further strengthen the evidence addressing these topics. An example of this is the multicentre, randomized study of early versus late androgen deprivation therapy (ELAAT). An example where a guideline in which I was senior author has a significant impact on patient and healthcare outcomes was the recent Cancer Care Ontario guideline on the use of low-dose rate brachytherapy. This conclusions of this guideline led to a Cancer Care Ontario funding decision, allow patients with intermediate-risk disease to have access to this highly effective (97% 5-year biochemical control) with only one outpatient treatment (compared to 16-39 treatments).
- Radiation Oncologist and Scientist, Sunnybrook Health Sciences Centre
- Co-Chair, GU Disease Site Group, Program in Evidence-Based Care, Cancer Care Ontario
- Professor, Dept of Radiation Oncology, University of Toronto