New hope in prostate cancer battle

Thousands of men with prostate cancer could avoid surgery in the future thanks to a genetic discovery.

Men with high levels of certain genes are three times more likely to have a fatal form of prostate cancer than those with the lowest levels, scientists have found.

It is hoped a genetic screening test could be developed to pinpoint how aggressive the disease is, and to predict if prostate cancer will return in men who have been treated.

Doctors would be better able to distinguish aggressive tumours that require treatment from the slow-growing ones that could be monitored.

This could mean thousands of men avoid surgery and side effects like impotence and incontinence, according to the study published in the journal Lancet Oncology.

Around 37,000 men in the UK are diagnosed with prostate cancer each year and the disease kills about 10,000 annually.

At present, doctors can struggle to predict how aggressive tumours are and rely on combining factors to create a model for prognosis.

But now researchers at Queen Mary, University of London, have found that men with the highest levels of cell cycle progression (CCP) genes – ones that encourage cells to grow – are more likely to have the worst type of cancer.

These genes were an even stronger predictor of disease than the commonly used prostate-specific antigen (PSA) test, although PSA still played an important role.

PSA is a chemical produced by the prostate and levels are often raised when a man has prostate cancer.

The study, funded by Cancer Research UK, found that, for patients who had surgery to remove their prostate, those with the highest CCP levels were 70% more likely to have a recurrence of the disease.

If the results are confirmed in large clinical trials, experts hope a test for CCP gene expression could be used routinely alongside the PSA test.

Lead author on the paper, Professor Jack Cuzick from Queen Mary, said: “Our findings have great potential.

“CCP genes are expressed at higher levels in actively growing cells, so we could be indirectly measuring the growth rate and inherent aggressiveness of the tumour through our test.

“We already know that CCP levels can predict survival for breast and, more recently, brain and lung cancers.

“It’s really encouraging that this could also be applied to prostate cancer, where we desperately need a way to predict how aggressive the disease will be.”

The study looked at 703 men with prostate cancer – 366 men in the US who had undergone surgery to remove the prostate, and 337 men in the UK with cancer confined to the prostate who did not need immediate treatment.

Tissue samples were obtained during surgery or during the biopsy used to diagnose the disease.

These samples were tested for levels of 31 genes involved in CCP. Dr Lesley Walker, director of cancer information at Cancer Research UK, said: “This is important research that could one day help solve one of the biggest problems in prostate cancer treatment.

“For some men, detecting prostate cancer early could be lifesaving. For others, it could mean unnecessary treatment and serious side effects.

“This test isn’t yet available for routine use, but we’ll look forward to seeing the results of large clinical trials that will tell us whether it’ll be useful for all men with prostate cancer.”

Dr Helen Rippon, head of research management at the Prostate Cancer Charity, said: “This new research is an important development that could help answer one of the fundamental questions in prostate cancer research – distinguishing aggressive prostate cancer from slow-growing forms of the disease that may not require immediate treatment.

“Research in other cancer types has shown that looking at the genes involved in how a cell divides can help to predict how aggressive a tumour is.”

She added: “Of course, this technology must be comprehensively trialled in large numbers of men before it can be introduced into routine clinical practice.

“It will therefore be some time before men diagnosed with prostate cancer will see any direct benefit from this research.”