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Breakthrough in prostate cancer diagnosis


Prostate cancer

A genetic breakthrough promises to improve prostate cancer diagnosis.

British scientists have discovered 17 genes that radically increase the chance of carriers developing the disease.

The findings will help create a test to identify those at risk.

Until now academics knew of only six genes linked to prostate cancer, but the research gives a total of 23 that can be assessed in a simple spit or blood test.

The findings by the Institute of Cancer Research in London show men who carry any one of the mutations are on average three times more likely to develop prostate cancer than men who do not.

And some of the mutations give men up to a ten-fold risk.

In time the scientists believe men could routinely have a quick Deoxy ribonucleic Acid (DNA)/genetic material test, allowing doctors to calculate their cancer risk.

Those at high risk would be closely monitored, undergoing regular MRI scans to check for signs of tumours.

In men already diagnosed with prostate cancer, the test could pick out patients with the most aggressive disease, saving thousands from unnecessary treatment, while ensuring rapid attention for those whose lives are at risk.

The researchers found that men with four of the newly discovered genes were on average 11 times more likely to have aggressive tumours than prostate cancer patients without the genes. For one of the genetic mutations the risk of aggressive cancer went up 70-fold, the European Urology journal reported.

The study examined the DNA of 1,281 men with prostate cancer and 1,160 healthy men.

Stakeholders are campaigning for an urgent improvement in prostate cancer diagnosis, which is lagging years behind other diseases such as breast cancer.

The only test currently available for prostate cancer – the ‘prostate specific antigen’ or PSA test – is unreliable so is offered only to men over 50 if they request it.

Some 47,000 men are diagnosed with prostate cancer in the UK each year and 11,800 die from it. If the cancer stays contained in the prostate, it is often best to offer no treatment at all.

Yet doctors have no reliable way of telling which men are most at risk. Because of this lack of a reliable test, thousands of men with early prostate cancer needlessly have gruelling surgery, radiotherapy and chemotherapy each year.

Study leader Professor Ros Eeles said: “Men can receive a diagnosis of prostate cancer without really knowing how the disease is likely to affect them, but in future a test could pick out those who are likely to develop an aggressive disease and need intensive treatment.”

Meanwhile, research suggests a single blast of radiotherapy could save prostate cancer patients weeks of gruelling treatments.

High dose-rate brachytherapy – which delivers a powerful surge of radiotherapy direct to the prostate in one single session – is safe and effective for men with low-risk cancer, researchers found.

The findings, presented at the European Society for Radiotherapy and Oncology conference in Milan, suggest patients can be spared daily trips to hospital for bouts of lower-strength radiotherapy.

One-hit treatment also cuts the risk of side-effects, reducing the toxic impact of covering surrounding healthy tissue in radiation.

The researchers, from the Christie hospital in Manchester and Mount Vernon in London, found all men with low-risk cancer were clear of the disease three years after receiving the treatment, which usually takes just ten to 20 minutes.

It was also successful in treating some men with medium and high-risk prostate cancer – but in up to a quarter of these men the cancer showed signs of returning, suggesting a higher dose may be needed for aggressive cancer types.

The Daily Mail UK is campaigning for an urgent improvement to prostate cancer treatments and diagnosis, which lag behind other diseases such as breast cancer.

Some 15,000 men with prostate cancer receive radiotherapy every year – nearly a third of the 47,000 men diagnosed in Britain annually.

But powerful single-blast high dose-rate or ‘HDR’ brachytherapy is available in only ten NHS hospitals across the country.

The vast majority of men receive external beam radiotherapy, which bathes the entire pelvis in a low-powered radioactive beam. The external treatment is given over 37 days, requiring men to go to hospital every weekday for nearly two months.

Brachytherapy instead fires a higher dose of radiation via thin tubes directly into the prostate for a few minutes to destroy the cancer cells.

Because it is much more targeted, it spares healthy tissue from radiation.

Brachytherapy has been used in Britain for a few years, but has usually been delivered in several sessions of lower-powered doses, requiring men to visit hospital between four and nine times.

But the researchers, who tracked 441 men receiving the single-dose version, found it was safe and effective, at least for those with low-risk cancer.

Researcher Dr. Hannah Tharmalingam said: “These results indicate that high dose-rate brachytherapy is a safe and effective treatment for men with low-risk prostate cancer but further research is needed in medium- and high-risk patients to see if the results can be improved with a higher dose.

“This type of treatment offers an attractive alternative to surgery or other forms of radiotherapy as it has a comparatively low risk of side effects.

“It is also a patient-friendly option because the treatment can be given quickly at a single hospital visit.”

Experts welcomed the findings. Dr. Bradley Pieters, chair of the European Society for Radiotherapy and Oncology brachytherapy committee, said: “This research suggests that a single treatment of high dose-rate brachytherapy could be a very good option for many men with prostate cancer.

“The technology and expertise needed to deliver this treatment is not yet available in all cancer centres. However, given that it may offer time and money savings for hospitals as well as benefits to patients, there is a good argument for investing in this type of radiotherapy.”

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Prostate Cancer
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