The old saw about prostate cancer is, “You’re more likely to die with it, than of it.” In other words, many men who are diagnosed with the disease and don’t get treatment will ultimately die of something else (like heart disease) rather than the prostate cancer. For many men who have low risk prostate cancer (no or minimal cancer on DRE, PSA less than 10 and Gleason score of 6 or less), that’s absolutely true. On the other end of the spectrum, the vast majority of men who have aggressive, high risk disease (PSA over 20, Gleason score of 8-10, and/or tumor that can be seen or felt extending outside the prostate) usually require treatment, if not for possible cure, then at least to improve quality of life. But what about the huge group of men between the extremes?
To date, the DRE, PSA blood test, and pathologic Gleason score have fallen short in allowing many men diagnosed with prostate cancer and their doctors to decide whether they should be treated aggressively. However, researchers at Fred Hutchinson Cancer Research Center in Seattle are hopeful that a new blood test may improve our predictive capabilities significantly: http://seattletimes.nwsource.com/html/localnews/2015927820_biomarker17m.html. Janet Sanford and colleagues whittled down a long list of potential genetic biomarkers. Their “short list” may now allow separation between those prostate cancers that are indolent (slow growing and unlikely to be deadly) from the lethal ones. Although her work is very preliminary and needs to be confirmed in a much larger, more diverse patient population, these early results are quite promising.
- Patrick Maguire, MD