ACT-SMART Initiative

Think about the men you know. Of all your family members, partners, friends and colleagues, statistics show 1 out of 6 of will get prostate cancer. It’s a sobering statistic. When it comes to the prevalence and deadliness of cancer in the U.S., only skin cancer affects more men, and only lung cancer kills more men.

The ACT-SMART Initiative at the IPCR aims to transform prostate cancer from a disease that causes uncertainty, suffering and death, to one in which highly personalized approaches can change men’s lives. For some, it means preventing prostate cancer from occurring; for others, we’re eliminating the need for treatment. But overall, our goal is increasing the survival rate with all forms of prostate cancer.


The number of men diagnosed with prostate cancer in 2018.


The number of men who died of prostate cancer in 2018.

3.1 M+

The estimated number of men living with prostate cancer.

The IPCR has two primary goals for the ACT-SMART Initiative:

  • Accelerating the discovery of life-changing treatments by making clinical trials and research more agile and informative.
  • Enhancing care by improving access to state-of-the-art prevention and treatment strategies.

These goals will be fulfilled by undertaking six primary projects.

Project 1 — Revolutionizing Clinical Trials with ACT-SMART


Testing new treatments is key to progress in prostate cancer. Unfortunately, the current model for conducting clinical trials — evaluating the effectiveness of therapies on human subjects — leaves a lot to be desired. Only one drug can be tested in each trial, and the time and cost involved reduce the total number of novel approaches that can be evaluated, slowing the pace of discovery.

Dramatic scientific advances in molecular biology now offer the opportunity for better strategies. IPCR faculty members aim to exploit these opportunities to establish a program that follows a new, dynamic and flexible model: the adaptive clinical trial.

Through our program, called Adaptive Clinical Trials-Survey, Measure and Redirect Therapy, or ACT-SMART, we will conduct studies that evolve in response to the information they are generating. Researchers use what they learn from each patient to make real-time adjustments as the trial proceeds. In this way, time and resources are diverted from unsuccessful strategies to more promising ones, enhancing both the pace of research and the quality of patient care.

By more rapidly improving our understanding of prostate cancer and its variation in individual patients, ACT-SMART trials will speed the development of strategies that match treatments (and secondary prevention approaches) to a patient’s needs.

Project 2 — Testing and Personalizing Therapies with the Tumor Avatar Library


While clinical trials are vital to medical research, testing new therapeutics usually starts with model systems in the laboratory.

Building on the pioneering work of Robert Vessella, Ph.D., we’re expanding our library of 26 tumor avatars — models of prostate tumors taken directly from patients — that represent a broad spectrum of prostate cancer subtypes. With this resource at hand, IPCR scientists can test novel therapeutics quickly and effectively, and the results direct our ACT-SMART studies in humans.

The tumor avatar library helps us discover which drugs are likely to work best in particular patients. We determine whether specific sequences or combinations of drugs show more potential than a single drug, without having to expose patients to potentially ineffective and toxic drugs.

By using tumor avatars and other tools, we enhance translational research and hasten the flow of leading-edge approaches from the lab bench to the patient’s bedside.

Project 3 — Unlocking the Potential of Genomic Research: Precision Medicine


Scientists have known for years that the human genome holds molecular keys to understanding and overcoming disease. The information encoded in the DNA (i.e., genes) of patients and their tumors has the potential to help us tailor treatment, postpone cancer recurrence and prevent tumor formation.

To unlock this tremendous potential, we take advantage of state-of-the-art DNA sequencing technologies. We also expand our resources for extracting and applying genetic data from blood, tumors and other biological samples.

Collectively, data from genetic analyses will serve as a valuable reservoir that researchers can plumb to better understand this complex disease. For instance, why some tumors are aggressive while others are indolent; why some tumors respond well to certain therapies, while others quickly develop resistance.

Researchers also use genetic data to create better care plans with more accurate risk assessments and informative, detailed diagnoses. Together, these plans produce a “precision medicine” approach that involves customizing therapeutic strategies to enhance treatment responses and reduce side effects.

Project 4 — Creating a Prostate Cancer Prevention Center


The prevention center complements other ACT SMART projects with two areas of focus: preventing prostate cancer development and relapse. It accelerates research by involving more men in groundbreaking studies and giving them access to leading-edge prevention programs.

The center offers prostate cancer patients the opportunity to participate in prevention research, including lifestyle and drug intervention studies aimed at prolonging disease-free survival — and improving quality of life — for men who have had or currently have prostate cancer. We also work with men with inactive cancer to identify and develop a panel of molecular markers that can be used to more precisely predict a patient’s prognosis.

The center includes a clinic for men who do not have prostate cancer, modeled on successful programs for breast, ovarian and lung cancers at Seattle Cancer Care Alliance. At the clinic, men at high risk for getting prostate cancer and susceptible family members can access evidence-based, cancer-related services, such as genetic counseling and prostate cancer screening, as well as strategies aimed at reducing cancer risk, such as weight loss and smoking cessation programs. Patients also participate in research directed toward identifying the biological factors that influence prostate cancer risk.

Project 5 — Building a Prostate Cancer Network


With the creation of the IPCR, the Seattle area has become a nexus for prostate cancer research and care. While that’s great news for men who can travel to Seattle to receive care or participate in clinical trials, what about the men who can’t?

We’re addressing this challenge through our statewide Prostate Cancer Network. The network allows us to recruit participants to new ACT-SMART, genetic and prevention studies. It’s also a two-way conduit, enhancing research
by increasing patient participation and speeding the delivery of promising new approaches to men across the state.

The benefits include:

  • Network member organizations can offer more and better options to their patients, so men can receive up-to-the-minute care in their own communities rather than having to travel long distances to the closest medical center.
  • The network increases the number of eligible men who can participate in clinical trials.
  • Researchers can access a larger and more diverse patient population for conducting studies and tracking patient outcomes.

Project 6 — Engaging Our Communities


Creating the Prostate Cancer Network is an important step in helping men across the state who have or are at risk for prostate cancer. We ensure men and their families are aware of the advantages of joining the network through knowledge and partnerships.

  • We developed an interactive portfolio providing information (in lay language) about state-of-the-art approaches for prostate cancer prevention and treatment, as well as ongoing prostate cancer research and clinical treatment studies — not only to encourage participation in clinical research, but also to empower men as they face complicated decisions about their care. We work to provide patient-focused programming, such as educational programs on UWTV, local and regional outreach, and an annual public symposium on prostate cancer research and clinical care.
  • We cultivate participation in the Prostate Cancer Network through physician education and by establishing formal relationships with regional medical centers, beginning with those in the Fred Hutch network and the UW Medicine health system, then expanding throughout the state and region. We also conduct physician outreach events at medical centers, participate in regional and national conferences, and provide physicians with educational materials to help educate and recruit patients to research studies.