Profile: Hashim Ahmed
Hashim Ahmed is an MRC fellow and urology surgeon based at UCL and University College Hospital. Katherine Nightingale caught up with him between surgeries to find out how he’s trying to change treatment options for prostate cancer patients on his ‘days off’.
Hashim Ahmed caught the research bug fairly early in his career, during a research project he undertook as part of his medical degree at the University of Oxford.
He was looking into the best conditions in which to grow nerve cells for potential implant into patients with Parkinson’s disease — pretty repetitive work by his own admission. “But that’s where I got excited about research. I was doing work that was advancing in small incremental steps but we were involved in something right at the forefront of research in that particular field.”
He then completed a more clinically oriented research elective in the US looking at how patients with spinal cord injury recover from surgery, and found he was hooked.
The prostate problem
Prostate cancer is relatively common — 40,000 men a year are diagnosed and 10,000 die. Current therapy relies on treating the entire prostate with either surgery or radiotherapy, but this can damage surrounding tissues and leave men incontinent and/or suffering from erectile problems.
But many men can live for years without their cancer getting worse. There is no way of knowing whether a man has one of these slow-growing tumours — or even where it is in the prostate — making decisions about whether to treat the disease difficult.
After his medical degree, Hashim continued his clinical training, specialising in urology. Alongside completing his urology training, in 2005 he began an 18-month fellowship with the Pelican Cancer Foundation looking into exactly these issues: how prostate cancer can be imaged more accurately so doctors know the location of the tumour, precise biopsy techniques so the type of tumour can be diagnosed, and ways to treat the disease without damaging surrounding tissue.
This gave him the pilot data he needed to apply for a two-year MRC Clinical Research Training Fellowship, which he began in 2008.
“In a nutshell, the first MRC fellowship research showed that MRI and these precision types of biopsy can detect, locate and characterise the cancer very accurately and that we can treat these individual areas of cancer very precisely, leading to a very low incidence of side effects.”
The treatment uses high-frequency sound waves to vibrate and heat only the cancerous tissue, killing the cells. Hashim describes this as being “like a lumpectomy rather than mastectomy in breast cancer”.
Two small trials of this ‘focal therapy’, of 20 and then 41 patients, suggested that the treatment is safe — with drastically fewer side effects — and effective in controlling cancer in the short term.
Hashim and his colleagues are now running a clinical trial in a number of centres across the country which will test whether the results are reproducible in other hospitals. He’s also going to apply to the National Institute for Health Research for funds to carry out a randomised controlled trial where focal therapy is compared directly against standard treatment.
This kind of surgical clinical trial is unusual and they can be difficult to carry out. “The traditional head-to-head randomised control trial is not working in surgery,” says Hashim. He is now working with the MRC Clinical Trials Unit to develop new designs for surgical randomised controlled trials.
Thriving on research
Hashim is in the first few months of a five-year MRC Clinician Scientist Fellowship.
The security of the fellowship is allowing him to be more ambitious in terms of the research questions he asks. Rather than having to cobble together funds for research from various different charities, “this has given me the confidence that this work will be supported for the next five years”, he says.
But this hasn’t made him complacent. “As somebody who really thrives on research, the thing it allows me to do is really grow and build in more studies on top of those I intended.”
For Hashim, being able to carry out his research and clinical careers in parallel has been vital not only to his career, but to the way he approaches both his research and clinical work.
“I haven’t felt like I’ve been disadvantaged compared to my purely clinical colleagues,” he says. “The clinical work and research go hand in hand. It’s through your clinical work that you get the ideas for your research — you stay in touch with the patients so you always link your research back to the priorities of the health service and more importantly the priorities of the patients.”
A three-track life
Hashim has a clinic one day of the week, surgery another and then three days to spend on research — the days, he says, that his clinical colleagues affectionately call his ‘days off’.
He has a three-year-old son with his wife, who is also an MRC fellow. Over time, he says, he has worked out the balance between the three spheres of his life: clinical, research and personal.
“I’ve got the balance that I need to remain motivated, to remain ambitious, to carry on in my career, without sacrificing the family side. I hope that I’ve got that right.”