Mr Adam Cox

After graduating from Cardiff University in 2006, I completed core surgical training and urology specialist training in South Wales.   I have always had a keen interest in diseases of the prostate which was further developed during a 2 year scientific research project into mechanisms of prostate cancer development at the European Cancer Stem Cell Research Institute.  I was subsequently awarded a doctorate higher degree (MD) from Cardiff University in 2015.   

During my training I published articles in scientific journals and have presented my research at both national and international meetings.  I have also won multiple national and international awards, and have written book chapters and educational review articles.

I am currently a Consultant Urological and Robotic Surgeon at the Aneurin Bevan University Health Board and my subspecialist interests include diagnosing and treating diseases of the prostate, including benign prostatic enlargement (BPE) and prostate cancer. 

The only urological surgeon in Wales trained to provide both robotic surgery for prostate cancer and Holmium Laser Enucleation of the Prostate (HoLEP), the gold-standard treatment for symptoms of benign prostate enlargement and urine retention.  I am fortunate to have been mentored by some of the UK’s leading experts in these subspecialist areas of urology.

I possess a detailed understanding of core urological conditions including urinary stone disease, chronic pelvic pain, incontinence, blood in the urine (haematuria), and vasectomy.  In my NHS practice I jointly run the erectile dysfunction service and I am motivated to provide a holistic approach when managing this sensitive problem.  

Since developing a close relationship with the Rutherford Cancer Centre in Newport, and following completion of an accredited training programme, I aim to be able to offer prostate-rectum spacers to optimise patient safety and minimise rectal toxicity in men prior to undergoing radical radiotherapy (with either proton beam therapy or photon radiotherapy) for prostate cancer.

I am passionate about surgical education and clinical research, both of which keep my clinical skills up-to-date.  I am an Assigned Educational Supervisor of Core Surgical Trainees for Health Education and Improvement Wales (HEIW) and an Honorary Lecturer of medical students at Cardiff University.  I am responsible for overseeing the early stage career development of trainee doctors, particularly around the management of urological cancers, a role in which I take enormous pride. 

My current research interests include the investigation of invisible blood in the urine (haematuria) and same-day discharge prostate surgery to minimise the complications associated with inpatient hospitals stays.  I actively recruit to urological cancer trials and I am currently co-Principal Investigator of a clinical trial aiming to optimise the surgical treatment of prostate cancer (METAL trial).

My non-clinical organisational and managerial interests centre on NHS service re-design to improve diagnostic pathways and patient experience by employing Patient Reported Outcome Measures (PROMs). 

I am clinical lead for ongoing quality improvement projects which will optimise the investigation of men’s urinary symptoms, and haematuria as a risk factor for urological cancer.

Diseases of the prostate (benign prostatic enlargement and prostate cancer) and erectile dysfunction.

I have an established interest in prostate cancer research, including the basic science of prostate cancer, and the investigation of blood in the urine (haematuria). 

Principle investigator for a number of clinical trials, and Honorary Lecturer at Cardiff University. 

Clinical lead for ongoing quality improvement projects which have streamlined the investigation of men’s urinary symptoms, and haematuria as a risk factor for urological cancer.

MD FRCS(Urol)

Year of first medical qualification: 2006

Royal College of Surgeons of England, Welsh Urological Society, Medical Protection Society

I am a Man of Gwent, having been born in Newport and raised in Newbridge.  I am the husband of a Clinical Oncologist and father to two young children. 

A rugby fanatic having played for Newport, Cross Keys and at international level in my youth. 

Consultant Urological and Robotic Surgeon, Aneurin Bevan University Health Board

Honorary Consultant Urological Surgeon, Cardiff and Vale University Health Board

Honorary Lecturer, Cardiff University

International

• Awarded prize for best scientific paper abstract                                           2016   

Bladder cancer project, The Global Congress on Bladder Cancer meeting, Brussels          

National

• 1^st prize for best poster presentation                                                             2014

Prostate cancer project, Royal Society of Medicine Urology section, Malcolm Coptcoat Spring Short Papers prize meeting, London

• Runner-up for the prestigious research ‘Patey Prize’ across all surgical specialties

Society for Academic and Research Surgery AGM (on behalf of BAUS), Cambridge University                                                                                                      2014   

Invited to deliver lecture in ‘Leading Lights’ session for young UK urologists           BAUS AGM 2013, Manchester                                                                 2013                                                                                                           

Regional

• BAUS/SURG (senior urology registrars group) Rep for Wales                       2014   
• Huw Williams Memorial Prize for Best Presentation                                    2013

Welsh Urological Society Spring Meeting

• Huw Williams Memorial Prize for Best Presentation                                    2012

Welsh Urological Society Autumn Meeting

• Huw Williams Memorial Prize for Best Presentation                                    2010

Welsh Urological Society Spring Meeting

Currently, publication of clinical outcomes in Wales is not mandatory in contrast with England.  My results are peer reviewed within my NHS department and my logbook is scrutinised at annual consultant appraisal. 

My outcomes for robotic prostatectomy and HoLEP are in line with those reported in the published literature.

MD Thesis

• Adam Cox.  Exploring mechanisms of prostate tumourigenesis in mouse models.  MD thesis, Cardiff University, 2015 (http://orca.cf.ac.uk/70907)

Peer-reviewed publications

• MT Jefferies & AC Cox, B Shorning, V Meniel, D Griffith, HG Kynaston, MJ Smalley, AR Clarke.  PTEN loss and activation of K-RAS and β-catenin cooperate to accelerate murine prostate tumourigenesis.  Journal of Pathology, 2017
• AC Cox, J.A Thomas.  Insertion of thermo-expandable metallic ureteric stents can be aided by ureteric pre-dilatation.  Ann R Coll Surg Engl, 2016 Feb;98(2):158-9
• AC Cox, M Kamarizan, M Hunter, JRM Wilson, DJ Painter, AC Carter.  Rejecting referrals for asymptomatic non-visible haematuria: implications of a change in practice.  Journal of Clinical Urology, June 2016; 9: 9-77
• L Evans, M Larsen, A Cox, R Skyrme. Steroids, drugs and stuttering priapism; the rock-and-roll lifestyle of a 24-year-old man.  British Medical Journal Case Reports, 2016: published online 28 January 2016
• M. Jefferies, A. Cox, A. Gupta, A. Proctor.  The management of acute testicular pain in children and adolescents.  British Medical Journal, 2015; 350:h1563
• A. Cox, M. Jefferies, H. Kynaston, A. Clarke.  Wnt, PI3K/Akt/mTOR, and MAPK signaling cooperate to accelerate prostate tumorigenesis in the mouse.  Journal of Urology, 2014; 191(4);e509
• A.C. Cox, M.T. Jefferies, H.G. Kynaston, A.R. Clarke.  Establishing a 3D primary tissue culture assay to explore self-renewal in murine adult prostate epithelial stem cells (PrSCs).  British Journal of Surgery, 2014; 101(S4):56–68
• A.C. Cox, M.T. Jefferies, H.G. Kynaston, A.R. Clarke.  Evaluating the roles of Wnt, P13k and MAPK pathways in prostate cancer.  British Journal of Surgery, 2014; 101(S4):2–49
• M. Jefferies, A. Cox, A. Bennett, H. Kynaston.  Management of lower urinary tract symptoms in men.  British Journal of Hospital Medicine, 2013 Sep;74(9):518-22
• A. Cox, B. Jenkins.  General anaesthetics - why have two when one will do?  Ann R Coll Surg Engl, 2011;93(4):334
• R. Harries, A. Cox, K. Gomez.  Until the Twelfth of Never: an Audit of Brest Cancer Follow-up in Wales.  European Journal of Surgical Oncology, 2010; 36(11):1108
• F. Soliman, BI Rees, A. Cox.  The Vagaries of the Cystic Artery at Laparoscopic Cholecystectomy. Journal of the International Association of Medical Science Educators (IAMSE), 2009;19(2S): 164 
• Peter R., Cox A., Evans M.  Management of diabetes in cardiovascular patients: Diabetic heart disease.  Heart, 2008; 94, 369-375
• Douglas-Jones A. G., Denson J. L., Cox A. C., Harries I. B., Stevens G.  Radial scar lesions of the breast diagnosed by needle core biopsy: analysis of cases containing occult malignancy.  Journal of Clinical Pathology, 2007; 60, 295-298

International podium

• AC Cox, M Kamarizan, M Hunter, JRM Wilson, DJ Painter, AC Carter, 2016.  Implications of rejecting referrals for asymptomatic non-visible haematuria: A single centre experience.  Global Congress on Bladder Cancer, Brussels – won award for best abstract

National podium

• AC Cox, MT Jefferies, HG Kynaston, AR Clarke, 2014.  Evaluating the roles of Wnt, PI3K, and MAPK pathways in prostate cancer.  Society of Academic and Research Surgery (SARS) meeting, Robinson College, University of Cambridge
• AC Cox, MT Jefferies, HG Kynaston, AR Clarke, 2014.  Establishing a 3D primary tissue culture assay to explore self-renewal in murine adult prostate epithelial stem cells (PrSCs).  BAUS Section of Academic Urology meeting, Robinson College, University of Cambridge
• AC Cox, MT Jefferies, HG Kynaston, AR Clarke, 2013.  Investigating synergy between the Wnt, PI3K and MAPK pathways in models of prostate tumourigenesis in vivo and ex vivo.  BAUS AGM 2013, Leading Lights session, Manchester Central Conference Centre

• AC Cox, BJ Jenkins, 2011.  Late recurrence of testicular cancer.  Royal Society of Medicine Urology Section Clinicopathology Meeting, RSM, Wimpole Street, London

Regional podium

• M Jefferies, A Cox, A Clarke, H Kynaston, 2015.  Assessment of cell signalling pathways to help risk-stratify patients with Prostate Cancer.  Welsh Urological Society Autumn 2015 meeting, Hensol Castle, Vale Hotel, Llantrisant
• A Hanks, A Cox, J Wilson, 2015.  Same day discharge after robotically-assisted laparoscopic prostatectomy: is this the new standard of care?  Welsh Urological Society Autumn 2015 meeting, Hensol Castle, Vale Hotel, Llantrisant
• A Cox, G Potts, R Skyrme, 2015.  A one-stop suprapubic catheter clinic improves patient safety for those requiring long-term bladder drainage.  Welsh Urological Society Autumn 2015 meeting, Hensol Castle, Vale Hotel, Llantrisant
• AC Cox, MT Jefferies, HG Kynaston, AR Clarke, 2013.  Exploring synergy between ß-catenin, Pten and K-ras mutations in prostate cancer in vivo and ex vivo.  Welsh Urological Society Autumn 2013 meeting , Copthorne Hotel, Cardiff
• AC Cox, ODM Hughes, HG Kynsaton, 2013.  Oncological outcomes of open radical retropubic prostatectomy (RRP) in the minimally-invasive era.  South Wales and South West Uro-Oncology meeting, Cardiff
• AC Cox, MT Jefferies, HG Kynaston, AR Clarke, 2013.  Development of an in vitro assay to enrich for prostate epithelial stem cells.  Welsh Urological Society Spring 2013 meeting, Conwy, North Wales
• AC Cox, L Sweeney, HG Kynaston, J Staffurth, 2012.  Outcomes of restaging imaging prior to salvage radiotherapy for BCR following radical prostatectomy.  Welsh Urological Society Autumn 2012 Conference, Angel Hotel, Abergavenny, Gwent
• AC Cox, HG Kynaston, 2011.  Is there a role for salvage radical prostatectomy after primary radiotherapy?  Welsh Urological Society, Conwy, North Wales
• AC Cox, BJ Jenkins, 2011.  Late Recurrence of Non-Seminomatous Testis Cancer.  University Hospital of Wales Grand Round Case Presentation Competition, UHW, Cardiff
• AC Cox, R Rajasundaram, M Agarwal, 2011.  Follow-up after augmentation (clam) ileocystoplasty – a practice and approach survey.  Welsh Urological Society Spring Meeting, Saundersfoot
• AC Cox, JS Phull, ODM Hughes, PN Matthews, 2010.  Improving Outcomes after Open Nephrectomy.  National Welsh Urological Society Spring Meeting, Oswestry
• AC Cox, JS Phull, O Hughes, 2010.  Resections of New TCCs of the Bladder.  Monthly M&M Meeting, University Hospital of Wales, Cardiff

International – moderated with presentation

• AC Cox, M Kamarizan, M Hunter, JRM Wilson, DJ Painter, AC Carter, 2017.  MP04 Why investigate asymptomatic microhematuria? Implications of applying UK national guidance.  American Urological Association 2017 AGM, Boston, MA
• AC Cox, MT Jefferies, HG Kynaston, AR Clarke, 2014.  MP49-19 Wnt, PI3K/Akt/mTOR, and MAPK signaling cooperate to accelerate prostate tumorigenesis in the mouse.  American Urological Association 2014 AGM, Orlando, FL
• AC Cox, MT Jefferies, HG Kynaston, AR Clarke, 2013.  Development of a 3D primary tissue culture assay to explore self-renewal in prostate epithelial stem cells.  European Cancer Stem Cell Research Institute Conference, Celtic Manor Resort, Newport, UK

National – moderated with presentation

• AC Cox, M Jefferies, M Kamarizan, M Hunter, JRM Wilson, DJ Painter, AC Carter, 2017.  The implications of rejecting referrals for asymptomatic non-visible haematuria prospectively for one year: an innovative interpretation of NICE guidance for ‘urgent suspected cancer’ (NG12).  BAUS AGM, ePoster P1-1 in Bladder cancer session, Scottish Exhibition and Conference Centre, Glasgow
• AC Cox, M Kamarizan, M Hunter, JRM Wilson, DJ Painter, AC Carter, 2016.  Rejecting referrals for asymptomatic non-visible haematuria: implications of a change in practice.  BAUS AGM, ePoster P2-2 in Bladder cancer management: Shifting sands, Liverpool BT Convention Centre
• AC Cox, MT Jefferies, V Meniel, A Gupta, HG Kynaston, AR Clarke, 2014.  A 3D primary tissue culture assay to prospectively isolate adult murine prostate epithelial stem cells.  National Cancer Research Institute 2014 AGM, BT Convention Centre, Liverpool
• AC Cox, MT Jefferies, V Meniel, A Gupta, HG Kynaston, AR Clarke, 2014.  Deregulation of Wnt, PI3K/Akt/mTOR, and MAPK signalling cooperate to accelerate prostate tumourigenesis in the mouse.  National Cancer Research Institute 2014 AGM, BT Convention Centre, Liverpool
• MT Jefferies, AC Cox, V Meniel, A Gupta, HG Kynaston, AR Clarke, 2014.  The effect of Wnt and PI3-Kinase signalling on prostate cancer and the stem cell population.  National Cancer Research Institute 2014 AGM, BT Convention Centre, Liverpool
• AC Cox, MT Jefferies, HG Kynaston, AR Clarke, 2014.  Optimisation of a primary tissue culture assay to purify adult murine prostate epithelial stem cells (PrSCs).  Royal Society of Medicine Urology section Malcolm Coptcoat Spring short papers prize session, London
• AC Cox, MT Jefferies, HG Kynaston, AR Clarke, 2014.  The Wnt, PI3K/Akt/mTOR, and MAPK pathways synergise to accelerate prostate tumourigenesis.  Royal Society of Medicine Urology section Malcolm Coptcoat Spring short papers prize session, London

‘Dear Mr Cox, further to your letter, I would like to thank you and your team for my operation on the 18^th June 2018 and subsequent follow-up.  Frankly I did not expect to have the successful recovery that I have made and consequently on my current lifestyle.  I have read Tolstoy’s War and Peace, had pleasant walks locally and in Oxford, a holiday in Lanzarote, and I am booked to go to Rome in February for the rugby international and for some sightseeing!  None of this would have been possible without the medical intervention I have received from you.  Thank you so much!’ – Delighted man after laser prostate surgery (HoLEP) – 2018

‘Dear Chief Executive.  I would like to express formally my sincere gratitude for the treatment I have received during my diagnosis, surgery and aftercare for prostate cancer.  The consultant, Mr Adam Cox, has been so supportive and positive throughout, and his professionalism and care has been absolutely excellent.  From my initial consultation, I feel I have received first class treatment, including biopsies, scans, pioneering surgery, the aftercare support network, and a prompt follow-up appointment.  I have been kept fully informed and every procedure has been explained in detail.  I cannot thank you enough, you have given me my life back!’ – Man pleased with his prostate cancer care under Mr Cox - 2018

 ‘Dear Mr Cox. Thank you for your kind consideration and help during my recent op and rehab’ - Satisfied man after laser prostate surgery (HoLEP) – 2018

‘Mr Cox, thank you for all the hard work you have put in to make sure that I am fit and healthy. I really can’t express my gratitude enough to you’ – Man after operation for testicular cancer – 2018

‘To Mr Cox.  Many thanks for all your professional care and help’ – Man investigated for suspected prostate cancer – 2018

‘Thank you Mr Cox and team.  Our sincere thanks for the speedy and efficient way you dealt with N on his recent visit for his prostate investigations’ – Man investigated for suspected prostate cancer – 2018

 ‘Dear Mr Cox.  Thank you for your professional consultation’ – Man with complex urological needs - 2019