When to wait, when to treat?

Researchers at the Hutchinson Center have a lead role in a new public/private partnership to create the first systematic surveillance program of men with prostate cancer to look for biological clues to help determine when to wait and when to treat the disease. The Canary Foundation and the National Cancer Institute announced the project on Friday.

Dr. Pete Nelson, of the Clinical Research and Human Biology divisions, will lead the Canary Prostate Consortium. This group of six institutions nationwide will enroll men in a cancer-surveillance study to look for biomarkers—proteins in the blood that could predict prostate-tumor aggressiveness.

The Prostate Active Surveillance Study is meant to help answer a key question that has vexed physicians and researchers: When is it best to treat prostate cancer versus observation or “watchful waiting.” For most men with prostate cancer, the disease never progresses to become a serious health problem, yet most receive some sort of treatment, such as radiation or surgery. Such treatments can have side effects, such as impotence and incontinence, which can be worse than the low-grade cancer. Currently it is challenging to accurately predict when inactive or slow-growing prostate tumors will become aggressive.

“There’s an emerging consensus that we dramatically over treat prostate cancer in general,” Nelson said. “The overall prevalence of the disease in the population far exceeds the number of men whose disease progresses to cause serious problems. Yet, there are clearly many prostate cancers that behave aggressively and patients benefit from treatment. It is a challenging problem.”

In the study, men diagnosed with early stage prostate cancer will not be treated right away but will be closely followed in an active surveillance program involving regular collection of blood and urine samples as well as prostate biopsies. A new repository for blood and DNA samples will be housed at the Center and funded by the Canary Foundation. NCI’s Early Detection Research Network (EDRN), the federal agency that is partnering with the Canary Foundation, will establish disease-specific Common Data Elements, a biospecimen management system and a protocol oversight program. The EDRN data management and coordinating center is based at the Hutchinson Center under the direction of Dr. Zideng Feng of the Public Health Sciences Division.

The samples will be tested for proteins in the blood that can signal when indolent disease has progressed to more aggressive illness. Such biomarkers could help physicians better determine when to initiate treatment versus watchful waiting.

The Canary Foundation is providing initial funding for the Prostate Active Surveillance Study. The five institutions that will enroll patients are University of Washington, Stanford University, University of California at San Francisco, University of British Columbia and University of Texas Health Science Center in San Antonio.