Sir Peter Michael established the Peter Michael Foundation in 2003 to advance better diagnostics and less-invasive treatments of prostate cancer. The following is an excerpt from an October 15, 2020, video conference with moderator Lori Lesperance.
Sir Peter, can you tell us what motivated you to start foundations in the UK and US?
First of all, I accepted there was a problem with the way in which men were being treated with surgery. They didn’t get the best out of life before, during, or after having had prostate cancer. With previous experience I’d had with colorectal cancer, the solution turned out to be imaging—find the part that is offensive and do something about it. In prostate cancer, it is difficult to find an image of the cancer itself. We decided to support a program of research into prostate cancer imaging.
How were men with prostate cancer treated differently back then?
The treatment men had was equivalent to the treatment women had for breast cancer thirty, forty, fifty years ago. It was a very crude operation that left a lot of damage and altered the quality of life. The chances of being impotent and incontinent after the surgery were very high. It was clear that we needed effective imaging and improved surgery.
Through my time with the foundation, I learned it was a “one size fits all” approach. If one’s PSA went up, the first thing to do was a biopsy. If cancer was found, the treatment was to remove the prostate. So basically, the number of men who were diagnosed with prostate cancer was vastly more than would die from it. Every man was being given the 100 percent solution with a lot of bad side effects. The foundation’s work with Memorial Sloan Kettering [MSK] and other institutions has been to help establish more sophisticated, more nuanced approaches to how men are treated.
Emily, can you elaborate on how you think prostate cancer affects everyone in a family?
I have a father. I have a husband. I have two boys. I have Pete. And it’s quality of life…knowledge is powerful, isn’t it? It affects our quality of life as much as our partners. More women approach the foundation on behalf of a male partner or family member. And that’s one of the reasons I love these PMF dinners and the connections we make. We like to say, come as a guest, and you leave as our friend. I’ve had wives come up to me saying, Thank you, he would have never picked up the phone without this dinner party.
When I started this, it was an idea that we might be able to influence local communities in Northern California. I had no idea we could do anything beyond that. I’ve been absolutely stunned by the results—people have come to us from all over America. It appears we are filling a gap that has not yet been filled. In many ways, not just in fundraising—people have been so generous to us. It’s clear they have a real interest in it.
Michael, back to the question of whether prostate cancer affects the whole family.
Twelve or so years ago, I attended a symposium in New York that was put on by the foundation and Hedi was a speaker. It was early in the conversation about prostate cancer treatment and imaging. This was so radical then, but it was the start of more mainstream conversations of the importance of imaging in prostate cancer.
Michael hit on a sensitive point, which is sometimes ignored by the surgical fraternity. Once a wife hears her husband has prostate cancer, many women feel that the first thing they’ve got to do is force them to get rid of it, have an operation. We know that whilst many cases are detected every year, the number of people who die from prostate cancer, as opposed to with prostate cancer is a completely different number. But that isn’t taken into account. And this is where the delicacy of the determination of what to do is absolutely essential.
Hedi, what led you to be in the radiology specialty then prostate cancer imaging?
Radiology is a unique specialty that combines life science and physical science. I was always interested in physics and mathematics. I like hard data, but also medicine. Therefore, I naturally gravitated to radiology, as it is a specialty that combines physics and medicine. I was fortunate to have access to MRI when it first became clinically available, and I was able to engage in some of the very earliest research on MRI of the prostate. This became an area of special interest for me, as it was intuitive that because of its exceptional ability to show the details of anatomy, MRI had the potential to be of value in the clinical management of prostate cancer. However, there was a lot of work to be done to show that it had a role to play in clinical practice. Almost two decades ago, when Sir Peter advocated for the use of MRI, there were a lot of controversies about the use of MRI in any pelvic tumors. He was a visionary ahead of his time.
Over time, we were able to run a number of clinical trials and gather data showing that Sir Peter was indeed correct. Today, MRI play critical roles in the management of prostate cancer—it enables image-guided biopsy; it contributes to the decision as to whether or not a patient should be treated and to the planning of treatment; and it is also used to detect prostate cancer recurrence.
You are an advocate for considering active surveillance as an option when the cancer does not appear to be aggressive?
In cancer care, it is critically important to know when to treat and be aggressive and when to step back and take a more cautious approach. Prostate cancer is a perfect example of a disease that varies greatly in its aggressiveness. Many patients who have prostate cancer die with but not of the disease, while for many other patients, the disease is lethal if left untreated. PSA and biopsy are essential for diagnosis. They are also used as biomarkers for treatment decision-making, but they are not perfect. When you add imaging, you gain additional information. MRI can be looked upon as a GPS for navigating human anatomy, as it identifies targets for biopsy and shows the location and extent of disease.
Hedi, can you talk about the biomarker used in a crossover application for breast cancer?
Prostate cancer and breast cancer share many similarities. Both prostate and breast cancers can be BRCA positive, and for both cancers, BRCA positivity is associated with elevated aggressiveness. In addition, both prostate and breast tumors are hormone sensitive. Prostate cancer is an androgen hormone–activated tumor, and that’s why we often use androgen deprivation therapy to treat it. Breast cancer is estrogen driven; however, as many as 70 percent of breast cancer patients also have androgen receptors, especially in metastatic disease. We have extensively studied a radiotracer for detecting androgen receptors in prostate cancer. Using PET-CT with this radiotracer, we detect metastatic lesions that are androgen sensitive in prostate cancer patients. We propose to use the same radiotracer in patients with advanced breast cancer also, to find those tumors that are androgen sensitive and, therefore, have a higher chance of responding to androgen therapy.
So how would prostate cancer have been treated five years ago, compared to today?
Well, the basic treatment options for primary prostate cancer are very similar. You can choose radiation therapy or surgery. Within the category of radiation therapy, many options exist, such as brachytherapy, intensity-modulated radiation therapy, and proton therapy. The choice of the right radiation-therapy approach depends on patient demographics, PSA, and detailed molecular pathology, but MRI plays a role as well. Similarly, in surgery today, there are various options, one of the most popular being robot-assisted surgery. Active surveillance is not a new approach either and was used as far back as 1989, though in those days, we called it “watchful waiting.” What has changed, apart from the name, is that the diagnostics we use now are more precise.
Michael, why did you choose to go to Memorial Sloan Kettering Center in New York.
I live in Florida and my primary care physician has been doing PSA tests on me for a long time. A few years ago, my PSA started to bounce around, and he wanted to do a biopsy. He said they would probably need to go in about three times, before they see anything. Knowing what I knew from the foundation, I said no. The next year, my PSA was okay. Two years later, my PSA jumped again, so I asked him to do imaging. This time it showed something. They did the guided biopsy and my results showed cancerous cells with Gleason scores. Happily, the scores were low. I knew I wanted to go see Hedi. She looked at my imaging and told me I needed to have my prostate removed.
Hedi, what role do the Peter Michael Foundation and other organizations play in allowing you and your team to advance imaging research?
With help from PMF, we train young, talented physician scientists, which is both a tremendous pleasure for us and a necessity for advancing the field of cancer imaging. While our research fellows learn new skills, they also bring new ideas and perspectives. As we mentor them, we learn from their questions. Our PMF-funded research fellows not only help us conduct important research, but, after they leave, they also spread knowledge across the world. There are former PMF fellows working in Austria, Switzerland, Germany, the UK, and a number of US sites, including MSK, and many of them are now in prominent positions.
Another key benefit of funding from the Peter Michael Foundation and philanthropic organizations generally is that it allows you to take risks and test innovative research ideas. It allows you to do a small-scale study and test a novel hypothesis. In contrast, when you apply for multimillion-dollar funding from the government, you need to have already conducted preliminary studies and compiled data showing that your idea is valid. So, without philanthropy, and without (in our case) the Peter Michael Foundation, we would not be able to take that first step and plant the seed for new discoveries. Philanthropic support is absolutely essential.
I do want to add that we owe great thanks to Michael Meyers for funding the Meyers Labenz Peter Michael fellowship at Sloan Kettering, under Hedi’s guidance. The combined breast and prostate cancer project is very promising, very innovative, and potentially enormously helpful to patients.
Walter, how does the foundation raise its money and how are the funds used?
We raise funds through donations and fundraising dinners. We establish Peter Michael fellowships. Or in some cases, it’s a named fellowship. In this case, the Meyers Labenz fellowship at Memorial Sloan Kettering for the project that we talked about earlier.
Michael, you’re funding that, right?
I wanted to be able to say thank you to Hedi and MSK for the wonderful treatment I received. I talked with Walter about what this fellowship was going to be. Sir Peter had early on recognized that prostate cancer for men is like breast cancer in women—Sir Peter drew that connection between them. I was a little bit skeptical—this just didn’t make sense. And so I find it ironic that the money we gave is now trying to prove a connection that I was skeptical about.
So Peter, what is your hope for future prostate cancer treatments?
For treatments, it’s detection, the treatment itself, and the after management, which have all made huge strides. But they are not yet perfect. We need better ways to detect prostate cancer without having to do biopsies. The treatment itself has come on enormously. The after treatment—psychological care, psychiatric care, and medical care—have plenty of space to improve.
How important is PMF’s fundraising in our current environment?
Regardless of COVID-19, prostate cancer continues—people develop the disease, and they need treatment. I’m talking to patients almost weekly, who know about us and helping them, so it is still an issue. We’re doing more online fundraising. We hosted one small COVID-compliant event this year, and we hope to do a few more small events. Once there is a vaccine, we plan to go back and do larger dinners in Miami, Chicago, New York, Omaha, Los Angeles, and San Francisco.
Emily, your foundation events are amazing—what is the value of these events?
They are wonderful dinners with beautiful wine. They’re personal and intimate. You get to talk to the scientists, you hear what’s happening at UCSF/Stanford/MSK—it affects everybody. We see the work these doctors are doing and have to take risks. We need to get these ideas moving forward—some will win, some will lose. But look how much we’re winning. It’s a very personal, enlightening evening. And it’s building awareness—spreading the word.
It’s also networking. I went to one because my husband had prostate cancer. I sat next to Walter and that eventually led me to help the foundation. So part of it is the networking of everybody in that room and whom they might know. If you think about the future, what do we need? What does everybody need to do to help the Peter Michael Foundation?
I would like to point out that the foundation is not just funding Memorial Sloan Kettering, they are funding great advances at other academic centers, such as UCSF, Stanford, Buffet Cancer Center, and Washington University, to name a few. They’re working with the best around the country to advance prostate cancer care. I personally love working with the Peter Michael Foundation, and I always appreciate how generous they are to so many academic institutions, how they listen and are never afraid to explore new ideas.
Your cause is advanced through networking and grassroots kind of organization, which is why we need to donate and give our time.
PMF has two projects we are funding that are treating prostate cancer at the cellular level. If a cell is cancerous, we need to kill it. If the one next to it is not, we need to save it. The idea is to eventually migrate away from tumor mass and treat cancer less invasively, at the cellular level.
We source, vet, and fund high-potential projects with the leading scientists and physicians in urology, oncology, radiology, and genomics on projects that will never get funded by the NIH or Department of Defense because they don’t have enough money or are deemed too risky (unproven). We need private funding to make this happen.