‘Prostate cancers’ not ‘prostate cancer’ – revealing the many faces of ‘one’ disease

Iain Frame
Dr Iain Frame of Prostate Cancer UK on the personalization of prostate cancer treatment

New research published today in Genome Biology shows that RNA sequencing could lead the way towards more personalized treatments for prostate cancer. In this guest post, Dr Iain Frame, Director of Research at Prostate Cancer UK discusses what this could mean for patients and health services, and what more is needed to provide effective support and treatment for men with prostate cancer.

We are used to hearing and talking about prostate cancer as a single disease.  Albeit a disease with its tigers and pussycats – the tigers being the aggressive cancers that move out of the prostate gland to other parts of the body, and the pussycats being those cancers that may never cause any harm and won’t go on to kill.  But it’s never quite as simple as that is it?

More and more we hear clinicians and research scientists talk about ‘prostate cancers’ plural. This is largely down to the introduction of genomic sequencing which has allowed researchers to identify and examine large numbers of prostate tumors, which initiate and progress in different ways. Add to this, the genomic variations in the men themselves, and suddenly the world of detecting and treating cancers of the prostate becomes a lot more complicated – not that it was ever simple to begin with!

What the paper published today by Drs Collins and Wyatt from the Vancouver Prostate Centre does so well is apply state-of-the art RNA sequencing technology to a real life situation. So on top of the information we know at the whole genome level, they looked at which genes were being used and disrupted at the point when the tumor was collected. Being able to match this up with how these men and their tumors had responded to different treatments meant that the researchers could then see which treatments work best for the different tumor types.

So in theory, by knowing more about the tumor and the man who has the tumor, researchers will be able to develop more personalized or tailored treatments for individuals. As a result, clinicians will be armed with a much clearer idea as to which treatments will work most effectively and speculation will be a thing of the past.

However, there is a ‘but’.  The researchers here only looked at 25 tumors and were surprised by the sheer number of genomic differences between them. Forty-thousand  men are newly diagnosed with prostate cancer each year in the UK and there are 250,000 men in this country living with the disease – so how much variation will there be when the number of tumors examined in this way increases?

The challenge lies in how we translate this fantastically elegant research into real life benefits for these men and those at risk of prostate cancer.  And what’s more – let’s not kid ourselves that it is only prostate cancer that is looking to tailor treatments – every other disease is working to the same aim, putting tremendous pressure on health services, which will need to cope with the increased expense of diagnosing and managing disease at an individual level.

At Prostate Cancer UK, we strongly support the development of new tailored treatments for men with prostate cancer. However, allied to that aim is an ambition to be able to take some men out of the system – those men whose cancer will never spread.

We feel that alongside developing better treatments, the global research community needs to develop a more robust risk assessment tool that can be used in multi-ethnic populations, delivered through primary care reasonably simply and in a cost-effective way. By doing this in prostate cancer we should be able to concentrate limited healthcare resources on those who need it most – those with, or at high risk of, aggressive prostate cancers.

There is absolutely no doubt that this is a really exciting time for prostate cancer research.  The results from this research will help build a better picture of what is going on and I’m confident that in the future it can lead to important health benefits for men with, and at high risk of, aggressive prostate cancer.

But that fight needs resources – both financial and human – to succeed.  It is clear that we must keep building on research successes such as the one reported here,  but for this to be possible, more funding is needed to support more scientists through their research endeavors in order to achieve real benefits for men.

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