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SOURCE: American Society for Clinical Pathology
Research Published in American Journal of Clinical Pathology Could Prevent Unnecessary Treatment, Lead to New Therapy
CHICAGO (PRWEB) June 27, 2012
Groundbreaking research has pinpointed four genes linked to prostate cancer, which could significantly improve diagnosis and treatment of this common cancer by identifying slow growing cancers that don’t need to be treated, and by developing targeted therapies for aggressive forms of the disease. The study appears in the June issue of the American Journal of Clinical Pathology, published by the American Society of Clinical Pathology (ASCP).
If the results are validated by larger studies, they could have significant medical and cost savings implications, potentially leading to the development of a simple lab test to determine the best course of treatment for men with prostate cancer.
One of the four genes, HEY2, shows particular promise as an indicator of aggressive prostate cancer, much as HER2 has been linked to aggressive breast cancer. As with HER2, therapies could be developed to target this form of prostate cancer, which is highly resistant to current therapies.
Every year more than 200,000 men are diagnosed with prostate cancer – the most common cancer in men according to the Centers for Disease Control and Prevention (CDC) – but 80 percent of those cancers are slow-growing and less than 3 percent are deadly. The majority of prostate cancer cases would go undetected and men would die with, not of, prostate cancer if they hadn’t received a positive result on the specific antigen (PSA) screening test, leading them down the path of further testing and treatment. Because currently, there is no method that accurately identifies whether a man who has tested positive for prostate cancer has the more aggressive form or the slow-growing form, most men choose to be treated. However, all forms of treatment, including surgery, chemotherapy and radiation, come with the risk of significant side effects, including incontinence and impotence.
“As with breast cancer, everybody wants to find the holy grail – the indicator of how the cancer will behave in the future, and what treatment, if any, is warranted,” said senior author Sharon Mair, MD, director of cytopathology at Grossmont Hospital, La Mesa, Calif. “I spoke to many prostate cancer patients who said they wish they’d never had treatment because they were left incontinent, impotent or both.”
If the results are verified, men who are identified as having slow-growing cancers can continue to be watched and tested, rather than undergo aggressive treatment, she noted.
In the study, researchers analyzed biopsy specimens of 240 patients who had been diagnosed with prostate cancer and had surgery to remove their prostates, and then followed their progress with the disease. Researchers analyzed antibodies to the protein products of 20 genes in both benign and malignant cells from each patient and then compared their findings to patient outcomes. Four genetic markers were clearly associated with prostate cancer prognosis – two of which were associated with slow-growing cancer and two with aggressive cancer – and all 240 patients tested positive to one or more antibodies to the four.
Of the 240 patients, 156 (65 percent) remained disease-free throughout the duration of their follow-up (from five years to 11 years and 10 months, after surgery) and were more likely to test positive for the slow-growing genetic markers and less likely to test positive for the aggressive genetic markers. In 84 of the men (35 percent), the disease progressed to biochemical failure (the PSA level rose but no tumor mass was detected), local tumor recurrence in the area of the prostate, or distant spread/metastasis, beyond the pelvis. Fifteen of the men had only biochemical failure; 45 had additional local recurrence and 24 had additional distant metastasis – the most aggressive and life-threatening cases – although none of the patients in the study died from prostate cancer during the study follow up period. Patients in this group were more likely to test positive for STMN1 and HEY2, and 32 percent of patients whose cancer spread distantly tested positive for HEY2.
“If these results are confirmed, we believe a simple kit could be developed to test all four antibodies to those genes,” said Omar Hameed, MD, ASCP spokesperson and associate professor and director of surgical pathology, Vanderbilt University Medical Center, Nashville. “This would provide the doctor with a risk assessment tool that could be used to help determine which patients should receive radical treatment and those who can be safely watched with regular prostate specific antigen (PSA) tests.”
More About ASCP
Founded in 1922 in Chicago, ASCP is a professional society with more than 100,000 member pathologists, residents, laboratory professionals and students. ASCP provides excellence in education, certification and advocacy on behalf of patients, pathologists and laboratory professionals.
More information about pathologists and laboratory professionals is available at http://www.ascp.org.
The American Journal of Clinical Pathology (AJCP) is the leading clinically oriented, peer-reviewed pathology and laboratory medicine journal that helps pathologists and other laboratory scientists stay current through application of evolving technology and techniques for diagnosis and improved patient care.
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