Patients like a medic in a white coat, but often mistake female doctors for nurses
Female physicians are 'unfairly judged based on appearance and attire, which affected patients' perceptions of professionalism and competency', according to a global review of the evidence around patients' impressions of what doctors wear.
'Female physicians are often judged more on appearance than their male counterparts,' it said.
'The way female physicians dress significantly influences perceptions of competence and professionalism, highlighting the gendered expectations that patients hold.
'Even when male and female physicians wore identical attire, female physicians were still more likely to be misidentified as nurses or medical assistants.'
The researchers found that 'gender-related perceptions of physician attire' existed across the 13 countries studied, including the US, India, Japan, China and Germany.
The paper, published in the journal BMJ Open, is based on an analysis of 32 previously published studies on perceptions of doctors' clothing.
'The expectations regarding attire are often gendered, particularly affecting the recognition and respect given to female physicians,' the paper's co-authors write.
Such behaviour is so widespread that hospitals and other healthcare providers should try to reduce bias among patients and 'foster equitable perceptions' of male and female medics, they add.
The white coat has been a symbol of medical expertise for decades. Its association in patients' minds with cleanliness and professionalism meant that 'white medical coats became the standard attire for physicians worldwide in the 20th century'.
Until then, doctors had generally worn black clothing to reflect the seriousness of meetings with patients.
People receiving healthcare find the white coat reassuring, the study found.
'Regardless of gender, patients exhibited favourable attitudes towards physicians wearing white coats, perceiving the physicians as trustworthy, respectful, skilled, communicative and empathetic.'
The white coat is still widely used by doctors worldwide. However, it was banned in the UK in 2008, when the government decided that medics working in the NHS should follow a 'bare below the elbows' approach to reduce their risk of spreading infections. The British Medical Association was unsure that evidence justified the change.
Despite patients' preference for doctors wearing formal clothing, the Covid-19 pandemic made them more accepting of scrubs.
'Patients tended to feel more comfortable with physicians wearing scrubs after Covid-19 ceased. While the traditional white coat is seen as a symbol of professionalism and trust, patients have increasingly accepted scrubs, especially in emergency or high-risk settings,' the researchers found.
Globally, male doctors seem to enjoy another advantage in many patients' minds as to what they wear.
'Patients' perceptions of male physicians' accessories have shown that details such as watches and glasses significantly impact professionalism and trustworthiness' and add to their perceived authority, the study found.
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Telegraph
2 hours ago
- Telegraph
The best hybrid mattresses for every sleep style, slept on and tested by experts
The products or services listed have been independently tested by our journalists. We earn a commission from the affiliate links in this article. Read more > Hybrid mattresses have risen in popularity since they entered the mattress market in the early 2000s. Combining a base of metal springs, to support your body and enhance the flow of air through the bed, and memory foam layers, which offer pressure relief and minimise motion transfer, their design showcases the latest in sleep innovation. We've tested 14 hybrid mattresses from market leaders, including Simba and Emma, as well as smaller specialist stores, such as Origin and Eve. We consider everything from the mattresses' composition to the quality of the delivery service and, of course, comfort, to finalise our rankings. Below, you'll find full reviews for the best hybrid mattresses in the UK, along with expert answers to your FAQs. If you're not sure whether a hybrid mattress is right for you, browse our best mattress guide, or take a quick look at our top five: The best hybrid mattresses: At a glance How to choose a hybrid mattress According to Suzanne Kugler, mattress buyer at John Lewis, there are three important things to consider when shopping for a mattress: 'The bed base your mattress will sit on, the level of comfort you're looking for, and the support you're seeking, which is often influenced by your sleep position.' A hybrid mattress works best with a supportive bed to bear the weight of dense foam and metal springs. A slatted frame or a platform bed will also enhance airflow, but they aren't always compatible with adjustable bed bases, so check that first. You don't need any additional support (like a box spring) because a hybrid mattress already contains coils. As a general rule, side sleepers appreciate a medium or medium-firm mattress with enough give to cushion their shoulders, hips and knees. Back and stomach sleepers should opt for a medium-firm or firm mattress to stop their hips from sinking too far into the surface, throwing their spine out of alignment. Kugler recommends visiting a mattress showroom for expert advice concerning how to choose a mattress. 'It's also worth purchasing from a retailer that gives you time to test the mattress at home,' she says. Around 100 nights is standard to break in your mattress and anything else is a bonus. How we test mattresses Our expert testers are all experienced product reviewers, with hands-on experience sleeping on multiple mattresses across a range of brands. They sleep on each mattress for at least a month in their own homes before writing any reviews. First, we assess comfort. They should provide pressure relief, easing any aches and pains and offer good ventilation to keep your body at a comfortable temperature. Next, we consider support, looking for mattresses that will keep your spine in a neutral position. We also assess edge support, which measures the sturdiness of the sides and stops you from rolling off the mattress. Then, we measure motion isolation, which is how well the mattress absorbs movement on either side. To test this, we fill a glass with water and set it in the middle of the mattress before applying pressure around it. The more it moves and spills water, the worse the motion isolation, meaning it should be avoided by couples and light sleepers. Finally, we judge convenience, including the quality of the delivery service, ease of installation, rotation requirements and any warranties, sleep trials and returns policies. Why you can trust Telegraph Recommended Our thorough, real-world tests will always help you find the best sleep product. No manufacturer ever sees Telegraph Recommended reviews before publication and we don't accept payment in exchange for favourable reviews, nor do we allow brands to pay for placement in our articles. All reviews are based on independent expert opinion and our hands-on testing. Visit our Who We Are page to learn more. The best hybrid mattresses of 2025 1. Best Buy Hybrid Mattress: Simba Hybrid Pro £1,199 for a double, Simba Score: 10/10 We like: Just the right balance of comfort and support, often sold with large discounts We don't like: No longer quite the cutting edge of mattress tech Reviewed by Simon Lewis Over the course of a career in product testing, I've slept on dozens of mattresses. The Simba Hybrid Pro isn't just the best hybrid mattress I've tried – it's the best mattress, full stop. It has seven sumptuous layers including temperature-regulating wool, various foams (notably, one is designed to be breathable) and multiple spring types. If you're upgrading from an old mattress, you might find all this a bit heavy and it's certainly thick, at 28cm, but it compares well to other hybrid mattresses. It balances comfort with support, moulds around pressure points and isolates movement while remaining invitingly bouncy. Simba also makes the elevated Hybrid Ultra, which is at the cutting edge of mattress tech, but I think the Pro is better value pound for pound. The price varies a lot over the year. I'd recommend waiting for one of its frequent, significant discounts around major sales events. Simba also makes some of our favourite duvets and pillows, so it might be wise to pick up a discounted bundle while you're at it. Key specifications 2. Best Value Hybrid Mattress: Origin Hybrid Mattress £375 for a double, Origin Score: 8/10 We like: Firm and supportive design with good edge support We don't like: Might feel a little firm for some Reviewed by Emily Peck Origin isn't as well known as some of the market-leading mattress brands, but its hybrid mattress gives Simba and Emma a run for their money. It took me a few nights to get used to the firm support, but after a week I was sleeping comfortably. Its 3,000 springs bore my body weight, while contouring foam relieves the pressure from my joints. I could feel the impact of the natural latex and organic wool, which worked together to keep my bed and body cool and dry. Its effective edge support also makes it easier to get in and out of bed. This is a bed-in-a-box, which arrives tightly wrapped in plastic for easier transportation up and down the stairs. Often with these, I notice an unpleasant chemical smell when new, but I didn't find that with the Origin Hybrid. Overall, there's a lot to like about this hybrid mattress, but I have one word of caution; it felt firmer than I'd expect for one that's rated medium-firm. Key specifications 3. Best Hybrid Mattress for Side Sleepers: Otty Original Hybrid Mattress £674.99 for a double, Otty Score: 9/10 We like: Good pressure relief, stable edges We don't like: Might feel too firm for some Reviewed by Emily Peck This hybrid mattress strikes a careful balance between sturdy spring support and comfortably squishy foam. There are 2,000 pocket springs, supportive high-density memory foam and an additional breathable memory foam within. Small perforations throughout the foam create air vents to funnel excess heat away from your body too. The Otty Original Hybrid had just the right firmness when I slept on my side, but may take some getting used to if you've previously had softer mattresses. It felt supportive and held its shape well. I was particularly impressed with the edge support as I could comfortably sit or sleep on the side without feeling like I was going to roll off. Price-wise, the Otty Original Hybrid is comfortably middle of the pack. It's more expensive than the Origin Hybrid, but you get a wider range of sizes and enhanced airflow technology, so I'd say it's worth the spend. Key specifications 4. Best Hybrid Mattress for Pressure Relief: Emma Hybrid Airgrid £824.25 for a double, Emma Score: 9/10 We like: The three-zone system to take pressure off joints We don't like: Takes a while to warm up on cold nights Different body parts need varying levels of support. What feels just right around your shoulders might feel too firm beneath your lower back. Emma's mattress aims to solve this problem with its zoned pocket spring base delivering specialised support to each area. It took me about a week to get used to it (there is a 200-night trial if you don't), but now I can feel the difference in my hips and shoulders. In all, there are seven layers in this mattress, including one of lower-density foam which, along with the springs, lets air flow throughout the mattress. It effectively regulated my body temperature, but on an extremely cold night, it took the bed quite a while to warm up. That's because memory foam uses heat to mould to the shape of your body, so when it's cold it feels a little unforgiving. I was particularly impressed with the motion isolation. I couldn't feel it when my partner moved around in the night, which is good news for light sleepers. The new smell did take a while to dissipate though, but handily, the moisture-wicking cover can go in the washing machine. Key specifications 5. Best Hybrid Mattress for Support: Hyde & Sleep Hybrid Ice Memory Foam Mattress £959 for a double, Dreams Score: 9/10 We like: Innovative design We don't like: It's not quite as firm as it claims to be Reviewed by Abigail Buchanan Where some hybrid mattresses are packed with dense layers of foam, which tend to trap heat and struggle to respond to the shape of your body, the Hyde & Sleep Mattress uses memory foam-shaped coils to mimic the bounce of a pocket sprung mattress with the cushioning effect of foam. In all, it has five different layers, including one that comprises over 1,000 micro pocket springs. The base foam is zoned for maximum support, too. But although the website describes the hybrid mattress as firm, I would class it as medium-firm and therefore suitable for stomach, back and side sleepers alike. You may need to try a few positions before you find one that feels right though. It comes wrapped in a knitted fabric cover, which feels cool to the touch, even through my fitted sheet – hence the 'ice' in its name. This kind of technology comes into its own over summer, but even in late autumn, it didn't feel too cold. It's a good option for hot sleepers who prefer a softer sleep surface. Key specifications 6. Best Hybrid Mattress for Back Pain Relief:Simba Hybrid Ultra £2,229 for a double, Simba Score: 9/10 We like: Unparalleled combination of bounce, support, comfort and heat regulation We don't like: The eye-watering price Reviewed by Simon Lewis Most hybrid mattresses have 1,000 to 2,000 springs and a few layers of different foams. This one contains 7,300 springs, five layers of foam and various temperature-controlling natural materials. There are 11 layers in total, which might sound like overkill, but once you've slept on it, other hybrids seem like works in progress. So, what do they all do? Well, the base is basically an entire pocket-sprung mattress in its own right, and it's what gives the Ultra its bounce. Above that are a layer of smaller springs and two layers of yet smaller micro-springs arranged to support the hips and shoulders. Other hybrid mattresses claim this kind of contouring, but the Ultra is the first where I can feel it; I have a bad back and this helps align my spine, reducing pain. Another function of the micro-springs is to stabilise the edges. There's no droop at the sides, so you can use the whole width of the mattress – an important consideration when two people share a double. Finally, you'll notice the thermoregulation. Towards the top are layers of natural fibres – including coconut, wool, bamboo, charcoal and kapok (a light and airy plant-fibre) – topped by a soft knitted cover. They give a gentle, floaty feeling and significantly reduce night sweats. It feels cosy in the cold too. I tried the Ultra as the seasons were changing and the temperature dropped by 10 degrees – it works. Key specifications 7. Best Hybrid Mattress for Hot Sleepers: Panda Hybrid Bamboo Mattress Pro £967.50 for a double, Panda Score: 8/10 We like: The excellent motion control and the washable top cover We don't like: The delivery service was a little lacking Reviewed by Leon Poultney This hybrid mattress has six layers, including a high-density memory foam base, a layer of zoned pocket springs and orthopaedic-grade foam. At the top, there's a final layer of bamboo-infused foam and a machine-washable bamboo cover, which is helpful as materials derived from the plant are known for temperature regulation and moisture-wicking properties. It is adept at isolating movement and preventing motion transfer, making it a solid choice for restless sleepers. But, while said to be medium-firm, I found it leans more towards the firm side. If you have any nerves regarding ordering online, the accompanying terms are generous – you can return it for a full refund if you don't like it after 100 nights. But the delivery experience wasn't as 'white glove' as others I've tested; I had to help lug my old mattress downstairs and dispose of the copious (but recyclable) packaging. If you like the sound of this mattress, but it's too expensive, you could also consider Panda's entry-level Hybrid Bamboo Mattress, which features uniform (rather than zoned) springs and a more basic version of memory foam. Key specifications 8. Best Pillow Top Hybrid Mattress: Dream Team Swaffham Combination Pillow Top Mattress £479 for a double, Dreams Score: 8/10 We like: Handles on the side make it easy to rotate We don't like: It's not so good in warmer months Reviewed by Rebecca Astill While 22cm doesn't sound deep in comparison to some of the mattresses on this list, this hybrid mattress has just about every layer imaginable. At the top is a cushioned, breathable layer (this is the pillow top its name refers to). It's designed to give you that springy feeling and it's encased in a soft knitted cover. Memory foam, pocket springs and a supportive base make up the rest of the mattress. The result is a luxurious, bouncy bed which offers pressure relief and support. As I've spent quite a long time reviewing mattresses, I generally make an initial judgement about the feel of a mattress by how it looks. I was completely wrong with this one. Instead of being a soft design that you completely fall into, it was supportive and reasonably firm. It needs rotating weekly for the first three months, then every month thereafter. That might sound quite high-maintenance, but the handles on the side of the mattress make turning the 34kg mass slightly easier. It's a small price to pay for long-lasting comfort. Key specifications 9. Best Hybrid Mattress for Couples: Eve The Wunderflip Premium Hybrid Sleep Mattress £999 for a double, Eve Score: 8/10 We like: Its soft and sumptuous topper makes for a cosy sleep We don't like: The firm side is still a little soft Why would I need a mattress that has a different tension on each side? I asked myself as I ordered a king-size version of the Eve Wunderflip to test at home. I eventually began to see the benefits; my partner and I disagree on the perfect mattress firmness, so having this dual-tension design means there's room for compromise. The mattress arrived rolled up and unpacking it and placing it on the bed was a two-person job. It reached its full 28cm depth within 72 hours and handles make it easy to flip and rotate. There's a medium side and a firmer side and the mattress comes with a deep quilted topper that can be zipped onto whichever you choose to sleep on. I spent half the week on the softer side and the other half on the firmer side and decided that the latter was the way to go. While I liked the plush feel of the softer side and was impressed with its edge support and finish, my partner (who is six foot) hankered for a stronger option. If you like a medium-firm to soft mattress, then this is a great option, but for anyone who likes a definitively firm mattress, consider the standard Eve Premium Hybrid Mattress instead. Key specifications 10. Best Hybrid Mattress Under £500: Dusk Original Hybrid Mattress £279 for a double, Dusk Score: 8/10 We like: Low price for a hybrid We don't like: Delivery can be slow Reviewed by Simon Lewis We've tried so many granite-heavy hybrid mattresses that a lighter, slimmer one that you can carry upstairs by yourself is a bit of a novelty. Plus, the top layer of Dusk's four-layer hybrid is made from a lighter-than-usual foam, constructed in a diamond pattern that makes it more breathable, for more bearable hot summer nights. As a result, it feels a bit softer than the claimed medium-firm description, which many people will be glad of. So why the remarkably low price? Well, four layers is common these days and there are fewer than 2,000 springs here compared to 5,000 in the Simba at the top of our list. It's also one-sided, meaning it won't last quite as long (although, as always, rotating it regularly will extend the lifespan). But at this price, the Dusk is pretty much a no-brainer for a spare room mattress upgrade, with the option to move it onto your main bed in the summer if you're in need of that extra breathability. Key specifications 11. Best Antibacterial Hybrid Mattress: Dream Team Gold Prescot Combination Mattress £699 for a double, Dreams Score: 8/10 We like: The clever liquid crystal Thermoswitch cover We don't like: The weight, which makes it tricky to rotate Reviewed by Kirsty Bosley When you think of 'liquid crystal' your mind may wander to a flat-screen TV before you'd consider a mattress. And yet that's what forms the temperature-regulating cover atop this mattress, and visibly jumps into action when you're overheating. How, you ask? Well, the grey cover turns white as it's working, something I saw first-hand when I laid my face, flushed from wrangling the weighty mattress into position, onto it. The soft-touch cover is antibacterial too and welcoming on cold nights. Some 4,092 pocket springs distributed my weight evenly and the deep layer of pressure-relieving memory foam added extra comfort to hips and shoulders. The memory foam is soft enough to sink into, but not so squishy that you end up trapped in an uncomfortable position. As a side sleeper, I found this gave me peace of mind as my old memory foam topper quickly developed dents that never really went away. It comes with a 100-night trial period, but I was sold on this British-made mattress after the first sleep. Key specifications 12. Best Hybrid Mattress for Motion Isolation: Otty Pure+ Hybrid Bamboo & Charcoal Premium Mattress £799.99 for a double, Otty Score: 8/10 We like: The bamboo- and charcoal-infused foam is both hypoallergenic and breathable We don't like: When it's not on offer, it's expensive Reviewed by Emily Peck I'm generally a restless sleeper, but I moved around less on this hybrid mattress, something that my partner noticed too. His movement didn't disturb me either – a testament to how well it isolates movement on both sides. The medium-firm mattress (which I think is a fair description) achieves this thanks to its 2,000 eight-centimetre springs, 2,000 four-centimetre springs and six layers of foam. Everything combines to create a balanced structure that provides excellent pressure relief. I felt like my body weight was evenly distributed. Two other materials are incorporated to keep things feeling fresh: breathable, moisture-wicking bamboo and odour-eliminating, hypoallergenic charcoal. The latter is important if you suffer from allergies and small perforations throughout the mattress increase breathability further; I slept at a comfortable temperature even when the thermostat had risen to 24C in my bedroom. Key specifications 13. Best Bed-In-A-Box Hybrid Mattress: Emma Hybrid Premium Mattress £448.80 for a double, Emma Score: 8/10 We like: Great for delivery and storage We don't like: Some will find it too firm This is a bit of a jump up from the Emma Hybrid Original Mattress price-wise, but you get tangibly more support. There are slightly softer springs to cradle your shoulders and hips and firmer springs to support your back. They're all 18cm tall, which gives room for air to flow throughout. Above them sits a firm, supportive memory foam, another foam layer that's breathable, and a final, pressure-relieving one for spinal alignment. Emma's other big selling point is the ease of its (free) delivery service; the mattress is in a box with a generous 200-night trial and money-back guarantee, so there's no risk if you decide it isn't for you. It also provides an old mattress removal service, which you can opt into at checkout. It's ready to sleep on within an hour of being unboxed – although it doesn't lose that slightly chemical 'new mattress' smell for a couple of days. It's also thinner than the mattresses above, at 25cm, and comes in four standard sizes (single, double, king and super-king). Key specifications 14. Best Firm Hybrid Mattress: Nectar Essential Hybrid Mattress £499 for a double, Nectar Score: 8/10 We like: The 365-night trial and lifetime warranty We don't like: It has a relatively basic design Reviewed by Emily Peck What's instantly enticing about buying a Nectar mattress is the company's 365-night trial and forever warranty, which is much more generous than your average offering. Knowing that you can return a mattress should you not get on with it is reassuring. But, having trialled it over the course of two months, the Nectar Essential Hybrid is a mattress that I'd happily sleep on for years. I wear an Oura ring that tracks your sleep quality and after a week, my score had noticeably improved. I have previously tried out the thicker and more expensive Nectar Premier Hybrid, which I found too firm. This one has a slightly softer base, offering better pressure relief for my petite frame. It comprises six layers of pressure-relieving memory foam and 600 individually wrapped 15-centimetre pocket springs, topped off with a quilted cooling cover designed to draw heat away from the body and circulate fresh air as you move. This seemed to work for me; I woke up in the morning feeling suitably refreshed. I'd recommend the Nectar Essential for anyone who wants a medium-firm mattress that is comfortable, breathable and supportive. Key specifications Hybrid mattress FAQs What is a hybrid mattress? 'A hybrid mattress contains two different types of fillings,' explains Kugler. 'You get the targeted support of a pocket-sprung mattress as well as the benefits of foam, which responds to the shape of your body for tailored comfort.' Are hybrid mattresses better than memory foam? 'This really depends on a customer's individual preference and what they're looking for from their mattress,' says Kugler. 'Before committing to one option, we'd encourage considering what level of support you're looking for. If you're looking for targeted support, a memory foam mattress might suffice, especially if the foam is arranged in ergonomic zones. If you prefer a bit of bounce in your bed, or you struggle to sleep in the heat, a hybrid mattress might be the more breathable option.' How long do hybrid mattresses last? 'I would say as a general rule that hybrid mattresses can last up to 10 years, but this depends on how the mattress is looked after over that time,' explains Kugler. 'To improve the longevity of your hybrid mattress, there's certain tips you can follow, such as rotating your mattress regularly to ensure that weight is evenly distributed across all of your bed.' 'I also recommend investing in a good mattress protector to provide an outer layer for ultimate comfort and guard against spills and stains.' It's also worth periodically cleaning your mattress. Are hybrid mattresses good for hot sleepers? 'Yes, they're great for those who get hot at night,' says Kugler. 'Because they have springs in them, the mattress is more breathable and better at distributing heat than many memory foam models, which retain and reflect heat in their dense layers.' Can you flip a hybrid mattress? 'Hybrid mattresses are typically single-sided with the fillings layered in a specific order for the best performance, so you don't need to flip them,' Kugler explains. 'However, I recommend rotating your mattress to ensure the even distribution of weight and, in turn, improve the lifespan.'
The Sun
3 hours ago
- The Sun
The common deadly fan mistake experts say people do at home that could trigger heart attacks
WITH August's scorching weather showing no signs of letting up, staying cool at home has become more essential than ever. This is why an electric fan is likely to become your new best friend for the coming weeks, while you try to take the edge off and feel cooler. 2 2 But a new study from Australia suggests using the humble device could do more harm than good by increasing your risk of a heart attack. Scientists from the University of Sydney recruited 20 people to test how fans affect body temperature, heart rate, sweating and comfort when used in a hot and humid environment. They also wanted to find out whether hydration levels made any difference, since it's already known that fans can sometimes make heat stress worse. The participants completed the experiment in a climate-controlled chamber set to 39.2C with 49 per cent humidity. In two of the sessions, they were well hydrated, having consumed the recommended amount of fluids for 24 hours beforehand, and were also allowed to drink during the trial. In the other two sessions, they were deliberately dehydrated by avoiding fluids and foods with high water content for 24 hours and were not permitted to drink during the trial. Each hydration state was tested both with and without the use of a fan. A series of temperatures were measured, including their heart rate, rectal temperature, whole body sweat rate, thermal discomfort, and thirst level. The results revealed that fan use while dehydrated can worsen heart strain, which can eventually lead to heart attacks. The experts concluded that using a fan increased sweat losses by about 60 per cent, which could mean using a fan is more harmful if you are dehydrated. How to stay cool during hot weather The study lead, Connor Graham PhD said: "Most extreme heat decedents do not have air conditioning but often own electric fans. "Fan use can reduce heat-related elevations in thermal and cardiovascular strain at temperatures up to approximately 39 to 40C. "In hotter conditions, fans should be turned off, as they can worsen heat stress.' This, Connor said, is because the high temperature of the air causes the body to heat up faster than it can cool itself by sweating. This isn't the first time fans have been linked to an increased risk of heart issues. Previous research has found that fan use can reduce heat and heart strain in temperatures up to around 39C, but once the mercury edges past 40C it's better to turn them off. Researchers have previously also recommended only using fans when it's below 39C for healthy adults below 40 years old and 38C for older adults 65 or older. They also warned fans should only be used in temperatures above 37C in older adults on anticholinergic medications like oxybutynin for bladder control.
Telegraph
4 hours ago
- Telegraph
‘Tailored' prostate cancer treatment can give men extra time
Men with incurable prostate cancer could be given precious extra time by tailored immunotherapy. Scientists have said a new drug combination has had an 'extraordinary' effect on some patients with no other hope, keeping the disease at bay for more than four years. The Neptunes trial found that the drug cocktail could extend life when conventional hormone therapies have stopped working, shrinking tumours when given to the right patients. Hormone-based drugs that block the production of testosterone, slowing or halting the growth of tumours, have become a front-line treatment for many men with metastatic prostate cancer that has spread to other organs. However, the cancer eventually becomes resistant and finds a path to keep spreading. The Telegraph is campaigning for the introduction of targeted prostate cancer screening to boost early diagnosis. A late diagnosis of the disease has been linked to a far worse survival rate. Men diagnosed at an early stage have five-year survival rates of almost 100 per cent, compared to rates of around 50 per cent once it has spread beyond the prostate. Dr Gianmarco Leone, an oncology researcher from the UCL Cancer Institute and the study's lead author, said the trial's findings were particularly promising because the 74 patients enrolled all had advanced cancer and limited options. He said: 'With the standard options, the time that these patients could still benefit from treatment was measured in months, definitely not years. But for a small group of patients, we've seen these extraordinary responses where we were able to achieve long-term benefits.' Previous attempts to use immunotherapy to treat prostate cancer have been largely unsuccessful, with less than 10 per cent of patients responding to the drugs in trials. Compared with other cancers, many prostate tumours are 'immune-cold', which means they either cannot be recognised by the immune system or have a physical or chemical barrier that repels immune cells. But the new research discovered that certain sub-populations of patients with advanced prostate cancer can be exceptions to the rule. The trial by oncologists at University College London Hospitals (UCLH) examined the effect of a combination of immunotherapy drugs – nivolumab and ipilimumab. Some 70 per cent of patients whose tumours have 'mismatch repair deficiency' – which have up to 20 times as many DNA mutations as other tumours – responded to immunotherapy, delaying disease progression by an average of 10 months. In men with prostate cancer caused by the BRCA2 gene, which is better known for its link to breast cancer, 50 per cent responded to the drugs and subsequently went into remission for an average of 17 months. Among men with a high concentration of immune cells around the tumour, 43 per cent had a positive response to the treatment. As a result, a handful of participants were able to fend off the disease's progression for more than four years. Dr Mark Linch, a senior author of the study and consultant oncologist at UCLH, said the results pointed towards more personalised approaches tailored to an individual's tumours being the future of advanced cancer treatment. He said: 'I've been pushing this personalised approach, as unfortunately despite my advice, over the years, the pharmaceutical companies have tended to run very large trials in unselected populations [of prostate cancer patients]. 'And while that's been a winner for lung cancers, melanomas and other tumour types, it's not worked for prostate cancer. So this was our effort to test a new strategy.' Other scientists said they were particularly excited by the response rate in metastatic prostate cancer patients with mismatch repair deficiency. Nick James, a professor of prostate and bladder cancer research at The Institute of Cancer Research, London, said far more men should be tested in case they have mismatch repair deficiency and could benefit from the new treatment. Prof James said: 'This testing is not something that's done very much. So there are probably some patients who might benefit, who we're not testing and therefore never get this treatment.' However, current statistics have shown that mismatch repair deficiency is only present in around 2 per cent of patients, while BRCA gene mutations occur in less than 10 per cent. Although the Neptunes trial included 74 patients, other experts said they were keen to see the approach tested in a larger study of hundreds of patients with such sub-types of advanced prostate cancer. They added that trials could combine it with hormone therapy to see if a dual approach would improve response rates even further. Prof Prasanna Sooriakumaran, a professor of urology at the University of Oxford, said: 'It's really promising because prostate cancer was not previously thought to be very immunogenic.' 'Now we should see whether immunotherapy can have a synergistic effect with the proven treatments which are known to work.'
