Global collaboration, Nelson says, is the key.
Prostate cancer researcher Professor Colleen Nelson is thinking about the endgame. Not death – she’s far too much of a positive thinker for that. Her ethos is all about bringing together discoveries in the lab with the experiences of clinicians treating patients to provide better management and better outcomes.
Nelson says collaboration – globally, nationally, between sectors, disciplines, and within universities and hospitals – is the key. It’s a shift in paradigm from “publish or perish” to “collaborate or collapse”.
It’s something Canada does very well and Australia could unlock vast potential if it were to break down the silos that separate practitioners working towards the same goal. Nelson admits it’s a challenge, but the medical industry needs to fight against dogma and she longs for the entrepreneurial zeal, innovative and independent thinking demonstrated by famous scientists Isaac Newton and Charles Darwin.
And for those with prostate cancer, she says: “I am quite hopeful we can keep creeping out their timeline and extend men’s lives.”
She spoke to former CPA Australia chief executive Alex Malley.
Alex Malley: Colleen, what brings a Wyoming girl to Australia to be helping men with their issues?
Professor Colleen Nelson: This is my second time living in Australia and I fell in love with it the first time when I came here as a student in 1987. Under the immigration laws of the day you had to leave for two years before you could re-enter the country. We had our first two kids [of six] here and thought we’d definitely come back. But landing in British Columbia [after Australia] it’s pretty easy to grow a taproot there, it’s a beautiful place.
I’ve always been very translational in my outlook and so with my colleagues we founded the Vancouver Prostate Centre. That started with four of us and has grown to be about 200 people. And we have brought over C$100 million in funding. But my colleagues kept bringing me back and around 2006-2007, Queensland had transformed itself, there was so much innovation and technology and energy.
The government had built 39 brand new institutes with a real different vision. It created such a rich, innovative environment that it was a complete lure to me. The opportunities really fit with my own ethos of collaboration and technology and translation, and I felt I’d be able to make a difference.
Malley: For the person on the street, tell us what translational research is.
Nelson: Translational research is the process of making sure our research becomes applied. It’s taking the discoveries that we’ve made in science and properly channelling them into application, ultimately affecting the whole system by getting them adopted into clinical practice and into the health service. It doesn’t have the sexiness that some of the basic research has, but we are trying to change the system for the better.
My own research area is with advanced prostate cancer and making the changes to have men live through the course of prostate cancer with the best therapeutics we can come up with, while living a life that is well managed.
If you look at prostate cancer versus other types of cancer, men probably have prostate cancer for up to 10 years before it is diagnosed. Once diagnosed, it can be radically treated. They may have a nice remission, hopefully forever.
But in Australia about 25 per cent of men will have a recurrence within about five years. Once we’ve exhausted all the therapeutics we have, that may be 15 years from his initial treatment. So we’re really needing to look at prostate cancer as more of a chronic disease, though it’s still very much a lethal disease.
Malley: There seems to me to be a broader level of curiosity of scientific research than specialist clinical work. How do you feel that is balanced?
Nelson: The way to get that balance right is that clinicians and scientists have to work together on the disease.
Malley: How challenging has that been?
Nelson: It’s incredibly challenging. I think we were very blessed in the Canadian system that there is a real culture of trying to deliver the best care you can in the most integrated way, and bringing clinicians, specialists and scientists across disciplines is the most efficient way to do that. The other thing is that Canadians are very aware of what they would call the elephant next door. To punch above their weight as they do in science and clinical work, they know if they make critical masses of groups and cluster a lot of activities and people into cross disciplines, into teams, that [they] make much greater impact.
In Australia we struggle with the divide between the clinic and scientists, who are often put off into their silos.
Malley: Why do you think that is?
Nelson: There are practical drivers – the load of clinical care but also the financial reward of clinical activities versus science. There’s a stronger history here of not just “silo-ising” disciplines of science and clinical activities, but actually a reinforcement down to the individual level.
It’s very difficult even within our academic environment to build up teams because the metrics by which scientists are rewarded is all about their individual metrics. It’s all a very “I”-driven endeavour. And I’m a complete revolutionary against that.
Malley: So what have you faced in trying to bring that collaboration to an individualised model?
Nelson: I try to encourage people to understand that you can still be an individual within a team and everybody makes critical contributions. What we need are multi-disciplinary teams where, of course, you’re recognised for what your discipline is bringing to that team, but you need to refocus your efforts on the goal, not the metrics.
If we are going to try to cure prostate cancer, that’s going to take a coordinated team effort and we’re all going to have to pass our contributions to the next logical piece down the translational pipeline. The greatest reward that you have will be being a part of that bigger entity.
At the end of the day we want patients to be better managed and that’s going to take academics, clinicians, allied health, health economists and people that are outside of those sectors, as well as working with government and industry and business. So it’s not just multi-disciplinary, it’s a multi-sectored approach.
Each of those sectors has different metrics that drive it but when you coalesce the energy and the excitement and the drive of people toward a common goal, that’s how you achieve it.
It’s what we’ve done at our prostate centre in Queensland. We have the largest critical mass of prostate cancer work, 65 people and 20 different disciplines. When you take a disease-focused approach as we have, then honestly it’s easy to bring everybody together from those disciplines to channel their energies. We need to do the same to drive innovation into clinical practices. It is a cultural shift.
Malley: With all this work and these specialties, and having raised multiple funds to progress your work, where do you see the likely areas of breakthrough in long-term care?
Nelson: We’ve gone through a period of having basically no new therapies over about a 20-year stretch to suddenly having five or six that have been approved in the last two to three years. We know we can make inroads on impacting the time of survival and using less toxic agents. By recognising that many of the metabolic changes being induced by the androgen-targeted therapies are actually driving the progression of the disease, the silver lining of all of that is that we’ve got a ready-made toolkit of many drugs from the metabolic space that we can repurpose into prostate cancer management. I’m quite hopeful we can keep creeping out the survival timeline and extend these men’s lives.
"I try to encourage people to understand that you can still be an individual within a team and everybody makes a contribution."
Another breakthrough area is going to be embracing the complexity of the dynamics of the disease and the response of patients to any particular treatment. The Art of War tells us that strategically everyone knows the dynamic of change offers opportunity. It’s most difficult to change things in a static environment. And so looking smarter at the disease is going to help and I think we can borrow a lot of drugs to repurpose.
We will also develop new drugs, we will develop more holistic management protocols for men with advanced disease so that their quality of life as well as quantity is increased.
Malley: Do you ever think about questions around how life began? You’re living in it and you see the complexity every day. Does it give you another perspective?
Nelson: The complexity of our genomes is enormous and we have been hampered in science because we get chained into particular dogmas about what is important and what isn’t important. Think of our genome as a dictionary, that’s what its capacity is.
It has all those words in it but, of course, you can combine those words in a multitude of ways to make a novel. Millions, millions, trillions of different novels and compositions may come out of it. That’s really what our body does.
Malley: A deeply focused approach to things can take you to the dogma model, which is losing the very essence of curiosity. How do we maintain freedom and curiosity?
Nelson: We have to fight against the dogma. We need to be creative about ways that we encourage people to be independent and innovative in their thinking. People often think that academics are free, actually we are horribly institutionalised. I live it every day.
But I am such a fighter. I’m not going to be chained by the dogma. Once a dogma is established it’s very easy to keep regurgitating it – entrenching it further whether it is correct or not, and stagnate discoveries. And to actually publish something or try to prove something against dogma is so difficult.
Our institutionalisation as an industry stifles our innovation. We are told what to do and how to do it. When we have grant funding rounds it’s “we will fund this and we want you to work in this way to produce some particular output”. So we become kind of processing machines.
The thing I really long for, and which history really held for scientists, is true entrepreneurial, innovative freedom. I hate to think that it died somewhere with Isaac Newton or Charles Darwin. We need to embrace innovation because [that’s] what is going to drive our society forward.
Professor Colleen Nelson is founding executive director of the Australian Prostate Cancer Research Centre – Queensland, and chair of Prostate Cancer Research at Queensland University of Technology.
She is also the founder and director of the Australian-Canadian Prostate Cancer Research Alliance and chair of the Movember Global Scientific Committee which operates across 21 countries.
Nelson on limits …
The first thing you do is give up any time that you would allot to worrying and just get on with it. I grew up with a couple of hard principles that have been the spine of my life. One is that you never let anybody set your limitations for you. And so I’ve had a bit of a deafness to the outside world saying you shouldn’t do this or what are you doing or why would you do that? And if you want to do something, it’s about setting your mind to it and you will find a pathway to achieve it.
I see my science and my personal life as a journey, without over-planning, always in search of the journey and the exploration.
Many people have a family and a tradition where they grew up and their parents and grandchildren don’t stray very far from the big oak tree – I think I’ve always been “What’s next around the river bend?”
And the benefit of clinical trials
There is not enough engagement [in Australia] in terms of clinical trials. If you were [a patient] in Canada or the US, you would have a whole menu of clinical trials put in front of you.
It’s one of the greatest challenges here because it’s a chance to say, well, this doesn’t work, we need to try other things. That’s the only way that we can progress clinical discoveries forward.
The second opportunity lost is because we are not actively adopting new medicines into the clinic. The next set of innovations that come out have to be tested against the previous innovation. We are getting so far behind the ball that it is going to be very difficult to catch up.