Biological markers that predict aggressive cancer — that is, the kind that will kill you — have become a bit of a holy grail, especially in prostate cancer.
That’s because these cancers are not all the same. Some are extremely aggressive: They can and do kill, even men in their 40s. Others are slow-growing and only become a concern when they’re detected through preventive screening. These cancers, often referred to as indolent, don’t kill: Men die with them, not of them.
But science hasn’t been able to reliably tease apart which prostate cancer is which, so patients basically roll the decision-making dice with their doctors and choose either invasive treatment, along with its considerable side effects, or active surveillance. As a result, some cancers are overtreated — causing unnecessary suffering to the patient — and others are undertreated, leading to the patient’s death.
Genome-wide association studies (GWAS), i.e., studies that look at the association between genetic variants and a trait or human disease, have identified over 100 inherited variants (or mutations) associated with prostate cancer risk. Other studies are looking at blood, urine and tumor tissue for biological markers that can predict exactly who’s prone to aggressive disease. But many of these biomarkers haven’t been validated through large studies and so are not widely used in the clinic.
Dr. Janet Stanford, a longtime epidemiologist with Fred Hutchinson Cancer Research Center and member of the Program in Prostate Cancer Research, is hoping to change that.
In late June, her team published the latest in a series of studies pinpointing and then validating a clutch of blood and tumor tissue biomarkers that, she hopes, will in time enable men and their doctors to better predict if a prostate cancer is likely to be lethal or lazy.
“We know there’s a subset of men diagnosed with local-stage prostate cancer who go on to develop and ultimately die of metastatic disease,” she said. “We’re trying to find biomarkers that would tell us how we can better stratify that subset and treat them aggressively and monitor them more closely for early evidence of relapse.”
“We’re trying find something that has more predictive power than what’s currently available,” she said. “We’ve been trying to develop the tissue biomarkers to be complementary and add value to the Gleason score.”