Research at the University of Liverpool involving more than 500 prostate cancer patients has revealed two thirds of cases did not require urgent treatment, due to the absence of a protein that indicates progressive disease.
In the largest study of its kind, the international team of pathologists studied an initial 4,000 prostate cancer patients over a period of 15 years to further understanding into the natural progression of the disease and how it should be managed. The research, published in the British Journal of Cancer, could be used to develop a blood test to distinguish between aggressive and non-aggressive forms of prostate cancer.
Globally, prostate cancer is the fifth most common malignancy and accounts for 13% of male deaths in the UK. Studies have shown that men with non-aggressive prostate cancer can live with the disease untreated for many years, but aggressive cancer requires immediate treatment.
Pathologists found that the presence of a protein, called Hsp-27, in cancer cells was an indicator that the disease will progress and require treatment. The study showed, however, that in more than 60% of cases the protein was not expressed and the cancer could be managed by careful monitoring, rather than with active invention methods, such as drug treatment or surgery.
The protein normally has a positive function in the body, helping healthy cells survive when they are placed under 'stressful' conditions, such as disease or injury. If the protein is expressed in cancer, however, it can prevent the diseased cells from dying, allowing the cancer to progress. The team, supported by Cancer Research UK (CRUK) and in collaboration with scientists in London and New York, found that the protein can be used to predict how the disease will behave and could help doctors advise patients on how the disease could affect their daily lives.
Professor Chris Foster, Head of the University's Division of Pathology, explains: "Cancer of any kind is a very distressing disease and has the ability to impact on every aspect of a person's life. Chemotherapy and surgery can also have a significant effect on health and wellbeing and that is why it is important that we first understand the biological nature of the disease and how it will behave in each individual patient, before determining if and when a person needs a particular type of treatment.
"By studying the disease in a large number of men throughout the UK and over a long period of time, we have been able to get a more complete picture of how to manage the disease successfully, whilst limiting the negative impact it can have on a patient's life. The study also demonstrates the role of modern of Pathology, not only in establishing diagnoses but in determining if the subsequent management of individual patients is biologically appropriate for their particular condition.
"The protein – or biomarker – we have identified provides us with a signal that the disease will continue to progress. We know that at the point this marker is expressed, medics need to administer treatment to kill the cancer cells. We have shown that in the majority of cases, however, this marker is not expressed and therefore patients do not necessarily need to go through treatment to lead a normal life."
- C S Foster, A R Dodson, L Ambroisine, G Fisher, H Mψller, J Clark, G Attard, J De-Bono, P Scardino, V E Reuter, C S Cooper, D M Berney and J Cuzick. Hsp-27 expression at diagnosis predicts poor clinical outcome in prostate cancer independent of ETS-gene rearrangement. British Journal of Cancer, 2009; DOI: 10.1038/sj.bjc.6605227
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