An internationally respected urologic oncologist and surgeon, Dr. Holden has made original contributions to the field of urology, including introducing radioactive seed implantation to Los Angeles. He was also an early adopter of ultrasound-guided prostate biopsy.
Dr. Holden spoke to UroToday about research and involvement with the Prostate Cancer Foundation (PCF), the world’s leading philanthropic organization funding and accelerating prostate cancer research, at the American Urological Association’s 2017 meeting in Boston.
Dr. Holden, there is a story about the original impetus behind the launch of the Prostate Cancer Foundation that you were personally involved in. Could you speak to this?
The Prostate Cancer Foundation was launched in 1993, when Michael Milken was diagnosed with prostate cancer. Very well known, very active in his private life, he had also been very involved in philanthropy. After being diagnosed with this very serious condition, he quickly did research and discovered that, in 1993, there was virtually nothing going on.
As Dr. Holden recalls, Milken said something like: “…I get diagnosed with a really bad disease, and there are not many options for me, and my life expectancy is very limited.” (Eighteen to 24 months were the best thinking at the time.)
“Milken decided he was not going out without a fight, nor was he going to just write checks: he wanted to get involved in the culture, asking…. ‘If this is the most common cancer in men, and the second-most diagnosed cancer, why is there no funding?’ ”
At the time, there was about $1600 per patient of Federal government spending for each patient who died of prostate cancer, versus $4,800 for breast cancer and $5,800 for AIDS. In 1993, this did not make a lot of sense to a businessman like Milken.
You and he joined forces, I understand, to correct a shortcoming in research funding, advance an understanding of the this disease, and help promote the development of new treatments…
We starting getting into the culture, and then he [Milken] said to me: “We’re going to start a Foundation on prostate cancer, and do several things: increase the funding, because, as we had found when we visited the National Cancer Institute at that time, they didn’t fund anything for prostate cancer because “…there are no good ideas.” [We heard] …the same when we visited the academics: no funding. We said, ‘OK let’s get some money in there, and see if we can attract the best and the brightest.’
In the early 1990s, “…when we visited the National Cancer Institute, they said that they don’t fund anything for prostate cancer because there are no good ideas.”We went to Johns Hopkins. Jonathan Simons. MD, had just finished his oncology fellowship. We asked him: “Why do you work in prostate cancer? He said, ‘I find it interesting, but I was told by my mentors that it was career suicide to work in prostate cancer.” It turned out not to be career suicide for him: it turned out to be a really tremendous thing for his career.
[Jonathan Simons is currently the CEO of the Prostate Cancer Foundation.]
Why was there a lack of funding for prostate cancer research, despite its prevalence?
At the time, no one had looked at the science of prostate cancer. It had a bad reputation: it was considered to be a disease of old men. Old men would get it and then die. But with the advent of the PSA [test] men started being diagnosed earlier. Old men started becoming way older men, and patients came to live longer with the disease [as a result of earlier treatment].
What was the situation with prostate cancer treatments—both drug and other—at the time these efforts were underway in the early days of the PCF?
There hadn’t been a new drug for prostate cancer in 40 years. The pharmaceutical industry was not interested. Even though they recognized it could be a potentially big market, there were few or no scientific ideas on behalf of prostate cancer treatment.
So, a combination of the PSA test and greater public awareness helped to spur research interest and funding for prostate cancer, as did other successful campaigns…
At the time, women were very forward with their efforts on behalf of breast cancer awareness—fundraising for research into cures and support of their gender peers living with breast cancer. The same was happening in the HIV community, whose advocates were on the steps of Congress [lobbying for Federal research money].
As the goals of the Prostate Cancer Foundation focused on increasing funding for through a strategy [of increasing] public awareness, a lot of interest was generated. Early on, we saw that we had to make the point that this is a big disease that men didn’t like to talk about, and efforts aimed at public advocacy had to be started.
Your efforts to spur support for prostate cancer research had very specific goals…
Efforts were ramped up on three fronts: to get more money in the field; attract more high quality scientists; and attract industry to re-start efforts in drug development, which had long been neglected.
Three Goals of the Prostate Cancer Foundation
-- Get more money in the field
-- Attract more high quality scientists
-- Attract industry to a re-start into efforts in drug development
You and your colleagues launched a creative strategy to spur interest and activity in research and drug development…
We did something that was unique in its day. We invited all biopharmaceutical people who had any interest in prostate cancer, or those whom we thought would be logical to have an interest in prostate cancer, to retreats. During these meetings, scientists presented their research findings to their peers in a setting that promoted an informal exchange of ideas. Various academic/industry collaborations initiated across geographic and specialty lines as a result of these gatherings.
Fast-forward to today… The drug development environment has changed substantially, has it not, and the Foundation can claim success in achieving its goals…
The initial three goals of the Prostate Cancer Foundation have been met: getting more money in the field [of biopharmaceutical research], attracting a superior group of scientists, and attracting some industry partners to re-start efforts in drug development. So that was very successful.
The other thing was that we found out in 1993 that academics would spend about 30% of their time preparing grant applications, for which they would get [awards] about 7% to 10% of the time, depending on the year.
You said that the grant-writing and submission process, as reflected by the National Institutes of Health (NIH), and the NCI—National Cancer Institutes—was burdensome to busy clinicians, and that you wanted try to streamline the process at the PCF…
Scientists were spending an outsized amount of their time preparing lengthy grant applications, and enduring anxiety-inducing lengthy wait times to hear from the granting agencies. The Foundation’s benefactor, Mike Milken said that this was a “…waste of time and talent.”
The Prostate Cancer Foundation decided to streamline this process. PCF instituted a very short application process, with a grant application of 3 to 5 pages. And, in contrast to the lengthy wait time to hear whether a grant is funded [such as from the NIH], the Prostate Cancer Foundation had a better idea.
We said, give us a three-page application. We’ll let you know in one month. And, if we say we are going to fund it, we’ll fund it in six weeks. The Foundation is much less risk-averse than the NCI and willing to sign on to creative ideas that peers and Foundation reviewers believe have outsized potential for moving a field forward.
The Prostate Cancer Foundation also has a different take on research ideas that may be, say, creative outliers….
Because the Prostate Cancer Foundation is private, it exercises, its prerogative to take risks, which have often paid off for funder, investigator, and patient.
One excellent example of success is enzalutamide. It is the best story we have.
We attracted a group of doctors at UCLA to work in prostate cancer. They made a discovery. The discovery became a drug; the drug morphed into a company, and the company was sold for billions of dollars. UCLA received a $1.4 billion royalty in return and the drug it backed and is now wide use.
The Foundation also fosters collaborations. We consider ourselves a kind of scientific ‘swat team’. We are mobile; we troll the literature. Our Scientific Director spends his life on the road. We’ve been doing this for 25 years.
Over this time, the Prostate Cancer Foundation has funded research totally about $700 million. Beneficiaries number over 200 medical centers in19 countries.
Through its Young Investigator Program, the Foundation also invests in tomorrow’s medical advances, tomorrow’s talent, the theory being that most people often make their most significant discoveries in their ‘20s.
The Foundation also helps out with the burdens of funding the early research efforts of doctors who are in training and juggling too many obligations, and that this investment has paid off in the successes of the PCF’s grant recipients.
Young doctors in training have heavily scheduled obligations that do not leave much time for creative research projects. Recognizing this, the Young Investigator’s Program essentially underwrites the initial part of their careers, enabling the program’s recipients to spend some time pursuing research interests they developed when in training.
In a recent assessment of the productivity of the approximately 240 investigators the Prostate Cancer Foundation has funded over time, compiling data in terms of number of publications and other markers of progress, the Foundation determined that its investment in medical talent has generated $470 million in subsequent grant funding—funding that was generated following the Foundation’s initial grants to medical talent.
The PCF has determined that its investment in medical talent (approximately 240 investigators) has generated $470 million in subsequent grant funding.Moreover, many of the clinicians whose careers were launched via the Prostate Cancer Foundation over its existence, are now leaders in their field—the doctors who may themselves be training the next generation of urologists.
About the Prostate Cancer Foundation
The Prostate Cancer Foundation (PCF) is the world’s leading philanthropic organization funding and accelerating prostate cancer research. Founded in 1993, PCF has raised more than $700 million and provided funding to more than 2,000 research programs at more than 200 cancer centers and universities. The PCF global research enterprise now extends to 19 countries. PCF advocates for greater awareness of prostate cancer and more efficient investment of government research funds for transformational cancer research. Its efforts have helped produce a 20-fold increase in government funding for prostate cancer.
Written By: Gina B. Carithers