Making precision medicine for prostate cancer accessible to all, even to patients who live in regions far from large urban centers and less served at the level of specialized health centers. This is the goal of the project Capital urology (translated into English Capital Urology), conducted by the University Hospital of the Charité in Berlin, a reference structure for 4 million people. The project, as he says CancerWorld, involves the state of Brandenburg, an area inhabited by 3 million people and 30 thousand square kilometers large, and provides for the creation of a network – above all digital – of connection between local doctors and those of the University Hospital of the Charité. In short, Capital Urology is one of the first experiments in which we will try to bring progress to the patient’s bed and not vice versa: if it works, it will be the prototype for other diseases to be replicated in other geographical regions.
Create a network
The idea comes from the urologist Thorsten Schlomm who together with Tim Rödiger, a specialist in health systems analysis, involved more than half of the 240 urologists in the federal state of Brandenburg, each with a pool of about 3 thousand patients. They only need to have a computer or a smartphone on which to download a dedicated app and in which to enter the data that will then be conveyed to the hospital in Berlin.
First: organize the data
Normally you have data silos, with different bits physically stored in separate places, ”emphasizes Schlomm, who is professor of urology and director of the urological clinic at the Charité university hospital. “In this way it is impossible to retrieve all the information in one system. Today we have developed a system to centralize and structure all this data ”. And it’s very simple: the patient keeps a diary, accessible to his doctor and at the same time recorded and saved in the centralized database. The information concerns the state of health, the side effects of the therapies, pain and quality of life. But that is not all. The data is analyzed with two purposes: to study better and to obtain as much information as possible on the various types of cancer to identify the best therapy for the individual patient. For example, it may be discovered that two people, despite having prostate cancer with similar characteristics, have a different disease course and quality of life: in that case it can be very important to understand why.
The project in practice
People are recruited and involved directly by their trusted urologist, who remains the referring physician, but connected, through this network, to the Charité hospital. 300 patients with advanced prostate cancer resistant to hormone therapy have already joined the project, who, even if 100 km away from Berlin, will receive indications on treatments, prescriptions and references to participate in clinical trials, all without having to travel. Of the total participants, about 50-60% receive an invitation for tumor genome sequencing, a very important tool to learn more about the prognosis, course and best treatments for a certain type of prostate cancer. Patients with a mutation in the Brca genes or other genes involved in DNA repair mechanisms will receive inhibitors of polymerase enzymes (Parp inhibitors, such as oloparib, approved against prostate cancer last November 2020). Other patients will be invited to take part in clinical trials on new drugs: for example, patients with deletions of the Pten gene, with oncosuppressive action, could be involved in trials on Akt inhibitors, a central protein in cell proliferation and survival. tumor.
Benefits for all
Experts are already working to extend this model to other cancers, such as that of the bladder, and to melanoma, under the action of another Charité group, and subsequently to ovarian and endometrial cancer. And the approach could benefit everyone, according to the authors: both patients, who get and (understand) receive the most appropriate care, and pharmaceutical companies, since designing a trial with participants who meet the requirements saves time. for experiments.
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