I’m still in Baltimore at the Prostate Cancer UK Forum and conversations last night continued over dinner and well into the evening. But I was up with the larks again today, ready for another day full of presentations and discussions on the latest developments in prostate cancer research.
Today, we covered managing disease – from imaging, to diagnosis and from low-risk to high-risk prostate cancer, and how we’re starting to tell the difference between them.
Risk is a pretty hot topic for us at the moment, especially since prostate cancer risk isn’t just about whether or not you’ll get the disease, it’s about the odds of it being the aggressive, potentially lethal form. And so it was fascinating to hear the experts discuss the work they’re doing at the moment to try to identify those odds.
Yesterday, Dr Cory Abate-Shen presented her research and described how a team from her lab, and the Shen and Califano labs, all at Columbia University, has used state of the art computer programmes to combine information from mouse models of prostate cancer and human tissue samples to try to identify new biomarkers – specific proteins that identify both aggressive and non-aggressive prostate cancer.
This type of work is an important stepping stone to one day being able to tell for sure which men really need prostate cancer treatment. And for me – almost more importantly – is the potential for biomarkers of non-aggressive disease to be able to predict with reasonable certainty which prostate cancers will never cause problems in a man’s lifetime, so that he could safely avoid any treatment at all.
This led nicely into today’s discussions about how using imaging techniques like MRI and ultrasound to guide biopsies has the potential to increase the number of aggressive prostate cancers that are caught early enough for treatment, and while at the same time allowing ongoing monitoring of patients on active surveillance to make sure that the disease isn’t progressing.
This all sounds great, but while it’s starting to happen in some hospitals, it certainly isn’t available everywhere – which is where the best bit of today’s talks came in – when the researchers talked about the need to work together to standardise reporting methods so that they can compare results from different institutions and decide best practice, and how to bring down the costs associated with imaging techniques like MRI so that they can be used in more hospitals and community practices around the world.
Another ‘risk’ area that researchers are working hard to reduce is the risk associated with having the right treatment – how do we know which drugs will work for best for which man? This is clearly an important question and came through in a few of the questions you asked us. We spoke to some of the scientists to find out.
Ellen de Morree, a PhD student from Erasmus University in the Netherlands chose to answer the question of why docetaxel chemotherapy is still used when the success rate is so poor in her presentation this morning. She said: ‘It actually isn’t that docetaxel doesn’t work. Taxanes like docetaxel or cabazitaxel are very potent chemotherapy agents, it’s just that they don’t seem to work in all men – we need a better trick for figuring out who they are going to work for.’
This is what Ellen’s project is setting out to do – finding out what the difference is between two tumours that means one responds to one drug, and the other to a different one. This sounds like a really exciting project, and in keeping with the ‘let’s get together and make a difference’ spirit of this conference, after her talk today, one of the more senior scientists in the room offered to put her in touch with some of his contacts who he thought might help her move her work forward – which is great news for her, and great news for the men who might one day benefit from research like this.
We also asked Dr Gerhardt Attard from the ICR how close he thinks we really are to personalised treatment for prostate cancer based on genetic information about a man’s tumour. He said:
‘We think we’re actually getting really close to this. There are two clinical trials going on at the moment where we’re using genetic information to tailor treatments – working out who will respond best to certain drugs.’
So there you have it. Research is getting us closer to the answers we need, but we’re not there yet.
We need scientists – and men – to work together. First to figure out what the important questions are, and then how to answer them in a way that will benefit men not just in one hospital, or even one country, but around the world.