Dr Patrick Bowden is one of Australia’s most experienced stereotactic radiotherapy doctors, delivering more than 2000 courses of treatment in his 25-year career as a radiation oncologist.
After obtaining his medical degree from the University of Melbourne in 1994, he began his oncology career at the Peter MacCallum Cancer Centre.
Later as Director of Epworth Radiation Oncology, Dr Bowden established Australia’s largest stereotactic radiation therapy service.
Dr Bowden has both clinical and academic expertise and has been the principal investigator in a number of groundbreaking clinical trials.
The pathway to oncology research
Dr Patrick Bowden’s interest in prostate cancer treatment and research originally stemmed from a family history of the disease.
“My father and grandfather had prostate cancer, and I was always wanting to be involved in that field pretty much from my early days as a resident doctor,” Dr Bowden said.
A 2007 patient referral ignited an idea that would eventually lead to groundbreaking research and change the standard of care for prostate cancer.
Dr Bowden was referred a patient with stage four prostate cancer by Director of Urology at Royal Melbourne Hospital, Professor Tony Costello.
“The patient was only 54 and had a solitary secondary cancer in his spine. Professor Costello asked if I would treat him with radiotherapy to try to kill off that single spot.”
“No one had really done that at the time. It was always thought that aggressive radiotherapy treatment of stage four prostate cancer was pointless. We just treated these patients in a palliative way.”
“I treated that man with high radiotherapy and as it turned out he had a stunning response and five years later the cancer hadn’t progressed.”
It was the stimulus for Dr Bowden to look more deeply at targeted radiotherapy for patients with stage four prostate cancer to extend their life expectancy.
“Sometimes it’s just good luck, the way things unfold and lead you to explore a particular area more deeply. I’m happy to say that 18 years later, that first patient is still alive and well.”
World leading clinical trial
In 2014 Dr Bowden began the ICF-funded TRANSFORM trial – the largest prostate cancer trial of its type in the world.
Dr Bowden says in the past treatment for patients with stage four prostate cancer had been palliative.
“Historically, they’ve received hormone therapy which stops the ‘food supply’ to the cancer and hopefully starves it. That treatment has been around for 40 years, and it does do a good job in slowing down the cancer, but it also has considerable side effects,” Dr Bowden said.
The TRANSFORM study evaluated the effect of high dose, targeted radiation therapy for patients with metastatic prostate cancer that had spread to five or fewer sites.
The theory was that by killing off the early metastasised cancers, doctors could potentially prevent further rapid spread of the disease.
“If you get in early and kill the cancers you slow down the whole progression, stopping that spread and influencing the natural history of the cancer in a very positive way.
“The TRANSFORM trial has shown that we can control the cancerous sites with radiotherapy in about 90 percent of cases with virtually no long-term side effects of any significance.”
Dr Bowden says stereotactic radiation therapy has allowed a significant number of patients to delay hormone therapy and chemotherapy for a number of years.
Last year Dr Bowden published the long-term follow-up of the TRANSFORM trial in the International Journal of Cancer.
“We know that men who have this treatment live longer,” Dr Bowden says.
“Even though stage four cancer is technically incurable, we now have quite a significant proportion of those patients 10 years later who are still alive and well.”
Further trials shape the future
Dr Bowden has also led two other major prostate cancer trials in Australia.
ProSPER 82 examined the use of a protective gel barrier between the prostate and the bowel to prevent damage to the bowel during high dose radiation.
“What this trial has done is eliminate the major downside of prostate cancer radiotherapy – damage to the bowel, which often caused permanent side effects.”
“It’s made prostate cancer radiotherapy a much safer option, short and long-term, for men with prostate cancer.”
A further trial called PINPOINT used a novel implanted device to act as a beacon to more accurately target radiotherapy for men with a recurrence of cancer post-surgery.
Why donors are vital
Dr Bowden says Icon Cancer Centre is in a unique position to carry out research because of its ability to recruit sufficient patient numbers across the country.
“A lot of trials struggle to recruit patients, but I’ve got a loyal and long-term group of referring doctors who are interested in research as well as their clinical day-to-day jobs,” Dr Bowden said.
But he says funding is the number one challenge in all clinical trial work.
“None of it happens without funding. You simply can’t run these trials without it – it’s that simple. Funding is the limiting step.”
He says donors who help fund Icon Cancer Centre’s clinical trials should know they are potentially changing patient lives and cancer outcomes in the future.
“You’re contributing to something that benefits all humanity – tackling a devastating disease, achieving outcomes quickly, and doing it right here in Australia.”
Dr Bowden says clinical trial outcomes are already shaping the future of radiation oncology, with a focus on improving patient outcomes.
“It’s now become the standard of care in most countries around the world to offer stereotactic radiotherapy for metastatic prostate cancer. Using this treatment extends people’s lives.”
