by Namitha Kumar on  August 29, 2015 at 12:07 PM Health In Focus
 Personalized Treatment Could Have Better Outcome in Prostate Cancer
The prostate gland is found in males and is positioned below the urinary bladder and in front of the rectum. The prostate gland functions to produce prostate fluid which protects and nourishes sperm cells in the semen.

What is Prostate Cancer?

Prostate cancer is a cancer of the prostate gland cells. Prostate cancer is usually slow growing without indicating symptoms until the advanced stage.

Prostate cancer usually affects older men. Almost 80% of prostate cancer is found in men older than 65 years of age. According to statistics from the Centers for Disease Control and Prevention (CDC), prostate cancer incidence rates (number of newly diagnosed cases) in 2012 in US were highest among black men followed by white, Hispanic, American Indian/Alaska Native men and Asian/Pacific Islander.

Prostate Cancer and Personalized Medicine

Prostate cancer is closely linked to genes which makes it important to personalize prostate cancer treatment and management. Personalized medicine refers to medical care based on individual genetic makeup. Using genetics and genomics, treatment can be customized to the individual's genome.

A Personalized Approach to Prostate Cancer Management

Given prostate cancer's link to hereditary genes, it is important to take a personalized approach to treatment rather than the "one-size fits all" approach. In an article published in BMC Medicine in May 2015, researchers Sedelaar and Schalken from Radboud University Medical Center, Nijmegen, The Netherlands, suggested that using genetic and molecular classifiers to personalize treatment could have positive outcome and better survival chances for patients with castration-resistant prostate cancer. This type of cancer is resistant to all treatments that reduce testosterone levels.

Currently, the tools used for prostate cancer diagnosis and prognosis are generalized and include the prostate-specific antigen (PSA), ultrasound and guided biopsies, digital rectal exam, Gleason score (used in evaluation of prognosis using prostate biopsy) and TNM classification of tumors (cancer staging system where T defines the size of the tumor, N if lymph nodes are involved, and M if the cancer has spread to other sites). These tools have limitations and cannot accurately predict the course of the cancer in individual patients. They often result in over-treatment or under-treatment of the cancer.

Genomic and molecular classifiers have a greater potential to predict cancer prognosis in individuals. Two new classifiers for prostate cancer are now available to enable clinical decision making whether the patient should be treated or only undergo active surveillance: Prolaris which gives the cell-cycle progression score and the Oncotype DX Genomic Prostate Score. Prolaris is a test which measures tumor cell growth characteristics. The test provides 10-year prostate cancer-specific mortality risk. The Oncotype DX Genomic Prostate Score (GPS) measures the activity of certain genes in the tumor and enables the prediction of the aggressiveness of the prostate cancer. Patients with low-to medium-risk cancer can either choose between active surveillance or intervention.

The researchers also refer to the recent study by Den et al. who detailed the use of the cancer genomic classifier Decipher. The Decipher test enables the prediction of the probability of cancer spread after prostate cancer surgery and indicates the aggressiveness score of tumors. The Decipher test was used to identify patients with medium or high-risk prostate cancer who could benefit from early adjuvant radiotherapy after initial radical surgery, where the prostate along with some of its surrounding tissues were removed. Den et al. findings indicate the benefits of personalized approaches to prostate cancer treatment and management. However, the researchers Sedelaar and Schalken point out that the study did have some limitations as well.

Researchers Sedelaar and Schalken conclude that genomic classifiers could possibly be used with positive outcomes for a personalized approach to cancer treatment and care. They should however be validated in well-designed trial for their usefulness.


1. JP M Sedelaar & Schalken, A J. The need for a personalized approach for prostate cancer management. BMC Medicine 2015, 13:109 doi:10.1186/s12916-015-0344-1 Accessed on 22 August 2015 from







Source: Medindia

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