Mieke Van Hemelrijck¹, Carina Zhang²

¹Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK; ²TAU Editorial Office, AME Publishing Company

Correspondence to: Carina Zhang. TAU Editorial Office, AME Publishing Company. Email: tau@amepc.org.

Editor’s note

Translational Andrology and Urology (TAU) has published a number of special series in recent years, receiving overwhelming responses from academic readers around the world. Our success cannot be achieved without the contribution of our distinguished guest editors. This year TAU launched a new column, “Interviews with Guest Editors”, to better present our guest editors and to further promote the special series. We also hope to express our heartfelt gratitude for their tremendous effort and to further uncover the stories behind the special series.

The special series “Expectant Management in Genitourinary Malignancies (Prostate, Bladder, Kidney)”(1) led by Prof. Mieke Van Hemelrijck (Figure 1) and Dr. Netty Kinsella from King’s College London has attracted many readers since its publication. This special series has focused on the current status of active surveillance in genitourinary malignancies, whilst highlighting the gaps for future clinical research. At this moment, we are honored to have an interview with Prof. Van Hemelrijck to share her scientific career experience and insights on this special series.

Figure 1 Prof. Mieke Van Hemelrijck

Expert introduction

Prof Van Hemelrijck studied for an MSc in Biomedical Sciences (2001-2005) and an MSc in Statistical Analysis (2005-2006) at Ghent University, Belgium. While doing so, she became engaged in epidemiology research in the field of urology. She continued her epidemiological training by spending two years at the Harvard School of Public Health (2006-2008), where she obtained an MSc in Population & International Health, staying focused on urological research. From 2008-2010, she worked with Professor Holmberg at King’s College London and obtained a PhD in Cancer Epidemiology. In 2012, she was appointed as a Lecturer in Cancer Epidemiology at King’s College London. She leads the Translational Oncology and Urology Research (TOUR) Team in the School of Cancer & Pharmaceutical Sciences and became a Professor in late 2020.

Interview

TAU: As a reputable expert in genitourinary malignancies, what drove you into this field in the first place?

Prof. Van Hemelrijck: I am a cancer epidemiologist and my team focuses mainly on prostate, bladder, and kidney cancer. These cancers are within the 10 most common cancers globally, nevertheless bladder and kidney cancer are often forgotten by the public as well as research funders.

TAU: Would you like to give us a brief introduction about why active surveillance (AS) uptake remains suboptimal in many healthcare settings?

Prof. Van Hemelrijck: I think this has to do with the fact that we still have to find the best signatures to predict (prostate) cancer progression, though we are making a lot of progress. Apart from having all the evidence, it is also partly influenced by how treatment options are communicated with patients. We have to consider the balance between the benefits of treatment versus the harms of treatment, including side effects and overtreatment. A lack of good patient signatures and differences in communication/support tools make it hard to implement AS uptake across countries and institutions. It thus shows us that biomarker discovery needs to be combined with implementation strategies. We need to consider barriers and facilitators (for patients and clinicians) with respect to uptake of new markers and their use in future treatments guidelines.

TAU: Humayun-Zakaria et al. hypothesise that a clinically useful detection test for bladder cancer based on a panel of DNA or RNA markers could become a reality within 5–10 years in this review article, what do you think of this hypothesis?(2)

Prof. Van Hemelrijck: There is an increase in studies in the field of bladder cancer and this will hopefully be the near future. Together with my colleague Prof Richard Bryan from the University of Birmingham, we are also starting a study (funded by Cancer Research UK) into the use of a new urinary biomarker for diagnosis of bladder cancer in clinical practice. We will combine this clinical study with a qualitative study to identify barriers and facilitators for uptake of urinary biomarkers beyond the typical standard care.

TAU: In several systematic reviews on the role of multi-parametric magnetic resonance imaging(mpMRI) in the active surveillance setting it was found that mpMRI can play an important role in optimizing the active surveillance management strategy, then how soon mpMRI can be of aid in reducing the burden of active surveillance? Would you like to explain more about your outlook?

Prof. Van Hemelrijck: I think for that we will have to wait for a bit longer. Our team is also involved in a prostate cancer project, funded by the Medical Research Council and Cancer Research UK.（3-6）This ReIMAGINE Consortium is led by Prof  Mark Emberton from University College London and is set up to help find better markers for progression in men with localized prostate cancer. We aim to develop a signature based on information from imaging as well as urinary, tissue, and blood biomarkers. This combination of MRI data with a variety of biomarkers will allow us in future to better predict the natural history of PCa.

TAU: Is the topic of this special series associated with any of your recent research projects? Would you please share some significant researches you are working on?

Prof. Van Hemelrijck: Yes, apart from the bladder cancer project with the University of Birmingham and the ReIMAGINE Consortium, my team works closely with Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) consortium（7）, which is now taken over by Professor Monique J. Roobol from Erasmus University in Rotterdam. This initiative has already resulted in more than 15 publications and brings together researchers and clinicians from all over the world.

TAU: If there is a chance to update this special series, what would you like to moderate, add or emphasize more?

Prof. Van Hemelrijck: I think there has to be much more focus on implementation of surveillance strategies. Research on the impact of surveillance methods on quality and quantity of life for patients as well as implementation strategies can be used to ensure that new surveillance methods can benefit both patients and clinicians when making treatment decisions.

Reference

1.  Expectant Management in Genitourinary Malignancies (Prostate, Bladder, Kidney).  Available online: https://tau.amegroups.com/post/view/expectant-management-in-genitourinary-malignancies-prostate-bladder-kidney
2. Humayun-Zakaria N, Ward DG, Arnold R, et alTrends in urine biomarker discovery for urothelial bladder cancer: DNA, RNA, or protein? Transl Androl Urol 2021;10(6):2787-2808.
3. Marsden T, McCartan N, Brown L, et al; ReIMAGINE Study Group. The ReIMAGINE prostate cancer risk study protocol: A prospective cohort study in men with a suspicion of prostate cancer who are referred onto an MRI-based diagnostic pathway with donation of tissue, blood and urine for biomarker analyses. PLoS One. 2022;17(2):e0259672. 
4. Marsden T, McCartan N, Hadley J, et al; ReIMAGINE Study Group. Update from the ReIMAGINE Prostate Cancer Screening Study NCT04063566: Inviting Men for Prostate Cancer Screening Using Magnetic Resonance Imaging. Eur Urol Focus. 2021;7(3):503-505. 
5. Green S, Tuck S, Long J, et al. ReIMAGINE: a prostate cancer research consortium with added value through its patient and public involvement and engagement. Res Involv Engagem. 2021;7(1):81. 
6. Santaolalla A, Hulsen T, Davis J, et al. The ReIMAGINE Multimodal Warehouse: Using Artificial Intelligence for Accurate Risk Stratification of Prostate Cancer. Front Artif Intell. 2021;4:769582.
7. Van Hemelrijck M, Ji X, Helleman J, et al; Movember Foundation’s Global Action Plan Prostate Cancer Active Surveillance (GAP3) Consortium. A first step towards a global nomogram to predict disease progression for men on active surveillance. Transl Androl Urol. 2021;10(3):1102-1109.