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Prostate cancers can often grow too slowly to threaten a man’s life. For this reason, many men who have early disease and do not carry a mutation linked to cancer would normally just be watched closely by clinicians, as the disease is unlikely to progress further.
1 in 8 men will get prostate cancer at some point in their life.
This makes prostate cancer the most common cancer in men, and the second most common cancer overall in the UK. Over 50,000 men are diagnosed with prostate cancer in the UK every year – that’s more than 100 each day.
The last decade has brought major advances in the way we diagnose and treat prostate cancer and men with advanced disease are living longer than ever. But, what are the most exciting research areas that have the potential to revolutionise prostate cancer treatment in years to come?
Ongoing prostate cancer research is looking at new treatment and early detection approaches, such as genetic screening, PSMA-targeting drugs and new targeted therapies,including precision medicines like PARP inhibitors and immunotherapies.
Targeted screening based on individuals’ genetic profiles
As our understanding of the genetics behind prostate cancer expands, it’s possible that simple tests could reveal someone’s risk of prostate cancer, meaning those at highest risk could benefit from more frequent screening, research identifying more than two thirds of the currently known genetic variants that increase prostate cancer risk – and could identify many more in the next decade.
“One of the main research areas undergoing a revolution in cancer research is the use of genetic discoveries to group and separate populations into different levels of risk, so that we can target early detection to those men that need it the most,”
Studies like GENPROS, an international study following men with changes in genes such as BRCA1, BRCA2, MMR or HOXB13, and following their prostate cancer diagnosis and treatment. The aim is to better understand how well treatments work in these men at higher risk.
A part of GENPROS is: should we use the same ‘active surveillance approach’ with men who carry certain mutations, such as BRCA2, for example? Along with GENPROS, PROFILE and IMPACT, two other studies investigating the most appropriate screening and management of prostate cancer in different groups of men at higher risk.
Improving diagnosis through liquid biopsies
This is where a second revolutionary area of research becomes important: developing and using new types of diagnostic techniques. For example, liquid biopsies – simple blood tests aiming to identify changes specific to the tumour which can direct the clinician as to where they should try new targeted treatments.
Liquid biopsies could transform clinical practice in the future, as they enable a new, more personalised approach to cancer treatment. Instead of using conventional tissue biopsies, which involve surgically removing a piece of the tumour and are invasive and painful, to analyse tumour DNA, researchers can use blood tests that pick up tumour DNA circulating in the bloodstream.
Last year, Professor Johann de Bono and his team used liquid biopsies to predict how well men with advanced prostate cancer responded to treatment with abiraterone with or without ipatasertib. Their research suggested these simple blood tests could replace some of the existing methods used to characterise and track the disease in the clinic.
When they analysed cancer DNA from the blood tests, researchers found specific genetic changes associated with drug resistance – which indicate that men are at risk of early relapse.
“These simple blood tests could help us track how cancer changes and stops responding to treatment. We are already using them as part of clinical trials and they are likely to eventually become part of routine care. Liquid biopsies are minimally invasive, cost-effective and can be performed often and with ease. Tracking prostate cancer with a blood test instead of a painful surgical biopsy could significantly improve patients’ quality of life,” said Professor Johann de Bono.
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