Rising to the challenge


John M. Fitzpatrick, Department of Surgery, Mater Misericordiae Hospital, University College, Dublin 7, Ireland. e-mail: jfitzpatrick@mater.ie


The Urology Foundation


Before 1995 there were effectively no charities in the UK the aim of which was to support research, education and training in urology. As a consequence, around that time, four charitable organisations sprung up and have since gone on to flourish; now, together, they raise >£20 million per year.

Both Prostate Action and the Prostate Cancer Charity (PCC) have focused on raising funds to support patients with prostate disease, to raise awareness and fund research to improve diagnosis and treatment. The Orchid Charity has a rather broader remit to improve the cure rates of all male cancers (testis, prostate and penis); while The Urology Foundation (TUF) aims to improve the treatment of all urological disorders through education and training of urologists, as well as sponsoring research [1]. Significantly, TUF was started with the invaluable assistance of a grant of £250 000 each from the BJUI and the BAUS.

Over the past 17 years much has been achieved with the funds raised by the combined efforts of these four major Charities, as well as by a host of smaller local ones. For example, the outstanding work by Professor Ros Eeles at the Institute of Cancer Research on the genetic basis of prostate cancer has identified >30 genes that convey prostate cancer susceptibility [2]. As a result of this work, eventually screening for prostate cancer may be targeted on those most likely to develop the disease based on the analysed configuration of their own individual genome.

New markers for prostate cancer have been identified. None of these have as yet superseded PSA, but prostate cancer antigen 3 has proven useful in refining decisions concerning biopsy and re-biopsy of the prostate [3,4]. Robot-assisted radical prostatectomy has become firmly established, and important lessons have been learnt about introducing this type of new technology safely and effectively [5,6]. High-intensity focused ultrasound is the ‘new kid on the block’ and extravagant claims have been made about its favourable side-effect profile [7], but its efficacy for effective cancer eradication is still unclear [8].

Arguably, in terms of clinical practice, the greatest advances over the past decade has been in the area of hormone-relapsed prostate cancer, where the introduction of chemotherapy with docetaxel and cabazitaxel, as well as newer agents, e.g. abiraterone, have significantly increased the life expectancy of men in this unenviable position [9]. Promising new agents, e.g. MDV 3100, are coming rapidly down the track.

TUF has achieved great things by the surgical training programmes it has funded. Rising stars in urology, including Ben Challacombe and Alan MacNeil, as well as a considerable number of other individuals, have benefited from the opportunity to work with and learn from the doyens of laparoscopic and robotic urology in the USA, including Indy Gill, Mani Menon and Jay Smith. The expertise they have acquired there has been passed on to very many trainees in the UK, keeping us up-to-date with the latest minimally invasive surgical techniques [1]. These important training initiatives help to make the introduction and use of these technologies safer and more effective [4,5,10].

From a personal viewpoint some of the most rewarding aspects of these many Charitable endeavours have been the trekking and cycling challenges that have taken us to the four corners of the globe. The fourteen of us who climbed Mount Kilimanjaro in 2003 not only raised >£200 000, found it to be a life-changing experience (especially myself, as one I was badly affected by acute mountain sickness at 5791.2 m). In 2007, the first ‘Hike for Hope’, which jointly raised funds for Prostate Action and Wellbeing of Women (WoW) took nearly 100 walkers across the Negev desert to Petra and raised >£650 000. More recently 10 of us trekked in Nepal, North of the Annapurna mountain range, from Jomsom to Lo-Manthang and back, raising £447 000, of which £20 000 was donated locally specifically to develop urological services outside Kathmandu [3].

In March this year 47 fund-raisers rode mountain bikes across the Andes in Patagonia to raise funds of >£316 000 for TUF. This was the fourth cycling challenge for this charity: in each previous year we have pedalled mountain bikes for 400 Km or so in Sicily, Malawi and Madagascar for that charity. In Madagascar we also raised money to provide basic equipment, including mattresses and mosquito nets for an impoverished hospital on the Eastern side of the island.

Another type of challenge in which we have been engaged over the past decade has been editing and developing the BJUI, which is also run as a charitable enterprise. We hope that readers will agree that considerable progress has been made and that the journal is now a truly global one. The time has now come to hand over to our successors. We have every confidence that the new team, aided and abetted by the BJUI executive, will rise to the challenge and take the journal to even greater heights of success in the future.


John M. Fitzpatrick is an advisory board member and lecturer at meetings sponsored by Sanofi-Aventis, Astellas, Janssen, GSK Orion, Hoffman, La Roche, Millenium and Takeda.