One of the most important questions currently facing prostate cancer practitioners is: How can we know which men diagnosed with prostate cancer have a life-threatening disease and therefore should not be enrolled in active surveillance programs?
Presently, no biomarker reliably distinguishes between aggressive and non-aggressive prostate cancer.
No one has figured out a way to identify men with prostate cancer that most likely will not cause harm.
Ultimately, the disease will progress in at least half of men, and thus they will have failed an active surveillance protocol. For them, their time on active surveillance amounts to a delay in treating an aggressive cancer.
This high failure rate and uncertainty is why only a relatively small percentage of men enroll in active surveillance programs.
Clearly, new biomarkers are needed that can help distinguish between aggressive and non-aggressive disease.
Under the clinical direction of William Catalona, MD and the basic science direction of John Witte, PhD, a new project involving the merger of the SPORE (Specialized Program in Research Excellence) Genetics Working Group and the SPORE Active Surveillance Working group has been created to address this question.
The combined efforts of these two groups bring together major research institutions, their scientists, and their previous research findings in both the genetics of aggressive prostate cancer and the results of organized active surveillance programs in prostate cancer patients.
Part of the impetus for this new combined project came from a genetics workshop in Washington DC, on prostate cancer aggressiveness organized in 2010 by Dr. Catalona and his research collaborators (sponsored by the National Cancer Institute and the SPORE Genetics Working Group of the National Cancer Institute) to bring together an international group of the most respected and experienced experts in the field of the genetics of prostate cancer. (See Winter 2010 QUEST, pages 1-3, on www.drcatalona.com)
Most prior studies have been focused mainly on the presence or absence of prostate cancer, and not on prostate cancer aggressiveness.
This new study hopes to: 1) find ways to identify men with aggressive prostate cancer who are enrolled in active surveillance programs, 2) find novel biomarkers that indicate aggressive prostate cancer, 3) discover cell signaling pathways that would result in potential therapeutic targets, and 4) examine aggressive disease in men of different ethnic backgrounds.
This project is exciting in its scope, but research projects involving genetic testing are expensive. Major philanthropic financial assistance will be necessary.
Hopefully, the end result will be an answer to the question of which patients can confidently choose active surveillance and which patients need immediate treatment.