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?
is a cancer of the prostate
gland cells. Prostate cancer is usually slow growing without indicating
symptoms until the advanced stage.
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
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
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
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.
tools used for prostate cancer diagnosis and
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
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.
also refer to the recent study by Den et
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.
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
1. JP M Sedelaar
& Schalken, A J. The need for a personalized approach for prostate cancer
management. BMC Medicine
doi:10.1186/s12916-015-0344-1 Accessed on 22 August 2015 from http://www.biomedcentral.com/1741-7015/13/109#