Prostate cancer originates from the cells in the prostate gland, which is responsible for producing the seminal fluid that nourishes and transports sperm
Daniel C. Danila, MD, Genitourinary Oncologist, Memorial Sloan Kettering Cancer Center shares talks about how precision medicine can help in prostate cancer treatment
The earliest confirmed case of prostate cancer can be traced back to the seventh century BC when the mummified remains of an Iron Age Scythian King were discovered. On inspection, experts found that the bone lesions on the remains were similar to those seen in patients with prostate cancer, expressing prostate-specific antigen (PSA). It was in the early 1800s when prostate cancer was diagnosed for the first time as causing death. During that time, the disease was considered rare. Almost 200 years later, prostate cancer is the fourth most common cancer to affect men worldwide.
Prostate cancer originates from the cells in the prostate gland, which is responsible for producing the seminal fluid that nourishes and transports sperm. Sometimes, a change in the DNA of these cells leads to the abnormal growth of a tumour. While in some cases, the cancer grows slowly and is non-threatening and requires little to no treatment; in others, it can be highly aggressive and needs urgent intervention. There are several risk factors associated with the disease such as obesity, race and diet, age (>50 years), and family history. Some symptoms of prostate cancer are blood in urine, blood in semen, significant weight loss, erectile dysfunction, difficulty in urination, and bone pain.
While what causes the disease is unknown, early detection is key in preventing the disease from advancing and leading to death. Though a serious disease, in a lot of cases, patients with prostate cancer do not die of it. However, in some cases, the cancer can metastasize rapidly. It is often called a cold tumour as the cancer cells do not trigger a response from the immune system. The heterogeneous nature of the disease requires an approach based on precision medicine that takes each patient’s physical, genetic, and biochemical makeup into consideration while creating a treatment plan.
Understanding Diagnosis and Treatment Options
A greater understanding of how prostate cancer develops has led to the creation of innovative treatments that make cancer therapy less daunting for patients. It has fostered confidence in individuals to undergo testing and treatment. If detected early when the cancer has not spread distantly, surgery or radiation therapy may cure this disease. Some patients with prostate cancer may require treatment due to the aggressive nature of the cancer, while some patients may require only active surveillance. For the patients in in low-risk group, the disease does not pose a risk until it progresses and requires treatment. The most common tests are a prostate MRI, digital rectal exam, PSA blood test, and a prostate biopsy. However, precision medicine can be incorporated into surveillance, thereby avoiding over-treatment and/or unnecessary testing. For example, molecular risk assessment can enhance the clinical decision-making process and predict the cancer pattern earlier, preventing unnecessary testing and ensuring timely intervention.
Depending on the severity of prostate cancer, treatment methods include radiation therapy, surgery, immunotherapy, and chemotherapy. Radiotherapy includes brachytherapy, proton therapy, and image-guided intensity-modulated radiation therapy, wherein the treatment and dose of radiation vary from patient to patient. The only surgical intervention for prostate cancer is radical prostatectomy, in which the prostate gland is removed. More recently, this method has been refined with minimally invasive procedures such as laparoscopic radical prostatectomy, and robot-assisted laparoscopic prostatectomy. Both procedures try to prevent damage to the tissues and nerves surrounding the gland. Surgical experience is crucial in these procedures to ensure optimal results and reduced risks of complications and side effects. Studies have shown that the more experienced the surgeon, the lesser the risk of recurrence and the greater the chances of survival. Immunotherapy is effective only in specific patients with metastatic disease and genetic sequencing may help in identifying patients who might benefit. Chemotherapy can also help in increasing survival and reducing the pain for patients whose prostate cancer has spread to the bones.
Precision and targeted therapies are opening new avenues in the field of clinical oncology and aim at enhancing the effectiveness of treatment while minimising side effects. Several novel methods have been employed in the treatment of prostate cancer. Focal therapy has emerged as a prime example of these therapies when it comes to treating prostate cancer. The treatment involves using extreme temperatures to destroy cancer cells. This therapy is used in the case of low to medium-aggressive cancers that are limited to the prostate. There are several types of focal therapy such as high-intensity focused ultrasound in which soundwaves are focused on the diseased tissues causing their destruction via heating, cryotherapy which involves injecting cold gases to freeze and destroy cancerous tissues, and laser ablation which uses a precise laser to burn away the cancer cells. In highly aggressive cases, doctors may choose to combine two or more therapies depending on the patient’s unique traits.
Modern therapies for metastatic disease have also been developed based on the molecular determinants of prostate cancer. These targeted therapies block specific molecules or signaling pathways in cancer cells or their surroundings. Examples of these include radioligand therapy (delivers radioactive emitters directly to tumour-associated targets), DNA repair inhibitors (PARP inhibitors), and antibodies that inhibit tumour neovascularization (VEGF inhibitors).
As newer technologies emerge, they also present opportunities for patients to participate in clinical trials. These trials provide patients with access to unique cutting-edge therapies and diagnostic techniques. By participating, these patients contribute to advancing medical knowledge and potentially improving treatment outcomes. Furthermore, they play a pivotal role in shaping the future of healthcare, benefiting both themselves and society.
Overlooking the seriousness of prostate cancer can have disastrous consequences. Through the adoption of tailored treatment courses based on each patient’s unique traits, precision medicine can boost efficacy and reduce the risks of complications and side effects. Furthermore, recent advancements in surgical, radiation, and medical therapies underscore the importance of a multidisciplinary approach in prostate cancer care. Moving forward, continued research and innovation in precision and targeted therapies hold promise for further optimising patient care and improving outcomes in prostate cancer management.
