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Prostate Cancer: No More Worried Waiting

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CLEVELAND (Ivanhoe Newswire) - Prostate cancer is the most common cancer in u-s men. While some will require harsh therapies, many men will have cancers that grow slowly and don’t need to be treated right away, or at all. Until now – it’s been a waiting game.

Mike Lewis and Don Buck both have prostate cancer. Doctors told Lewis to watch his tumor, but wait on treatment. “He said that in the mean-time I’m looking at this as something that [I’ll] probably die with, and not of,” Lewis told Ivanhoe. But Buck’s cancer became aggressive.“I had my prostate removed,” Buck told Ivanhoe.

Dr. Eric Klein says these kinds of patients are difficult to identify at diagnosis.

However, now there’s a new way. It’s called genomics. First, patients have a biopsy. Then, the test measures which genes are in the tumor.

“We can tell from that little amount of cancer how aggressive the cancer is,” Eric Klein, MD, Urologist, Cleveland Clinic, Ohio, told Ivanhoe.

As many as half of all prostate cancers in the U.S. are low-risk. About 100,000 of men in this category undergo treatment, even though there’s only a three-percent chance their disease will progress or become life-threatening.

“We now have the capacity to more accurately look someone in the eye and say, ‘Yeah, you do have a cancer, but it isn’t anything to worry about,’” Dr. Klein explained.

It’s a simple test that could save a life or spare a patient from harsh therapies.

This same method has been used for years to help predict if chemotherapy is necessary for breast cancer patients who undergo surgery. Doctor Klein says he believes there will one day be a similar test for all types of cancer.

For more information about the genomics test, log onto genomichealth.com .

RESEARCH SUMMARY

BACKGROUND:Prostate cancer affects hundreds of thousands of men each year in the U.S. This disease only affects men, but can be very deadly if not caught in enough time. The disease progresses slowly, so slow that doctors may not even catch it until it has taken a life. (Source:http://www.medicalnewstoday.com/articles/150086.php)

RISK FACTORS:There are no known causes of prostate cancer, but there are some risk factors that doctors warn their patients about. Though doctors do not understand the exact cause of prostate cancer, they do know that it is caused by the change in DNA of a prostate cell. Some risk factors of developing prostate cancer can be altered or changed, while others cannot. Risk factors including smoking, diet, weight and STIs can be changed or treated to help prevent the development of prostate cancer but family history, age, race, genes, and nationality are some that cannot be controlled. (Source:http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-risk-factors)

SYMPTOMS:Prostate cancer is a slow-moving process, but in its advanced stages, symptoms of prostate cancer can include
DR KLEIN: “This particular company also has a test on the market for colon cancer. They have some interesting data that was developed here on kidney cancer and other companies are doing other sorts of things. There isn’t a clinical trial for this now so this test is commercially available now. And it’s available to any doctor, but it’s mostly for urologists. If a patient is interested in this they should go to the General Health. Com website and read about it, ask the urologist about it. If they decide that they want to do the test the urologist’s office will enter the order at the company’s website. The company will contact the pathologist that has the biopsy slides and get that and then report back to the urologist. All they have to do is ask.”  

INTERVIEW

Eric Klein, M.D., Urologist at the Cleveland Clinic, talks about genomics as a way to treat prostate cancer.

Can you explain Genomics, I don’t think people hear about it very often?

Dr. Klein: Genomics relates to the genes that make up our cells and when disordered, can cause cancers to grow.  The study of genomics has to do with looking at DNA and how genes that drive cancer growth might be exploited clinically.

So now you’re looking at this to do what you do which is treat prostate cancer.

Dr. Klein:  This is a pretty exciting time to be in the field of prostate cancer. There’ve been lots of new drugs approved by the FDA for men with metastatic disease in the last few years. And there’s a recognition now that most newly diagnosed men who have low volume, low grade tumors probably don’t need to be treated at all. They’re more likely to die of something else, even just old age. The whole idea behind genomics and prostate cancer is to understand ,for those who are newly diagnosed, who needs treatment and who doesn’t. And for those with more advanced disease to pick specific treatments that target specific molecular defects in their cancers and slow down the cancer.

And it’s so hard because right now I have several friends who have prostate cancer and they’re all watchful waiting.

Dr. Klein: Yes.

And that is scary for everyone.

Dr. Klein: Yes.

Because there’s something in you, you know the cancer you’re supposed to go in and get it.

Dr. Klein: Yes. That’s our psyche in the United States. It’s not the psyche in the rest of the world but it is the psyche in the United States. The challenge for  physicians have been 'if I have two patients who have low grade cancer and one of them doesn’t need to be treated and one of them does I can’t really tell them apart based on how their prostate feels or what their PSA is or what their biopsy shows'. But this whole new test that’s been developed now and several others like it that are on the market or will be on the market soon really allow us a window in to the biology of the cancer. So we now have the capacity to more accurately look someone in the eye and say, yeah, you do have a cancer but it isn’t anything to worry about. Now, biologically we know that it’s not behaving aggressively at a biologic genomic level and it’s safe to watch for a while. Now that could change in the future. We can use these tools to monitor individual cancers so that if one looks like it’s getting worse then we can intervene and still cure the patient. So that’s why I’m excited by this. This is something we’ve been waiting for, for a very long time. We've been working hard to develop the ability to say to an individual patient 'you have a cancer that doesn’t need to be treated or you have a cancer and even though otherwise qualifies for surveillance actually needs to be treated.'

So this is for people who have already been diagnosed, this is not if you’re taking the biopsy that diagnoses it?

Dr. Klein:  This is for patients who are newly diagnosed. So if someone comes to us and has a biopsy because of concern about their PSA or the way their prostate feels like, it’s that piece of tumor that we take and send to the lab and use that to access whether or not someone needs treatment or not. Now technically it’s possible to do that on anybody who has cancer even if they’re ten or fifteen years down the road. But as we have developed the test it was developed for newly diagnosed men to help decide 'do I need treatment or not.' And one of the things that will come out of this, as we get more experience with it, is the opportunity to take a patient whose cancer was not very aggressive at the beginning and who goes on surveillance and who has another biopsy two or three years down the road. And then ask the same question, let’s say that biopsy still shows some cancer, how do we know that, that cancer is treading water, how do we know that it’s not getting a little more aggressive. And we could repeat this kind of genomic test and tell whether there’s been a change. You know where at the beginning the gas pedal wasn’t being pushed very hard? Well now it’s being pushed a little bit harder. That says to doctors ‘wait a minute we are no longer safe to watch, let’s go ahead and treat the patient.'

Was this test developed here?

Dr. Klein: It was developed here. The developmental work was done here and the validation work to test whether or not it worked in a separate population of patients was done at  the University of California at San Francisco. Genomic Health is the company that developed this. They are a well-established company. They’ve had on the market now a genomic test for women with breast cancer, newly diagnosed breast cancer, for about ten years. It’s widely used. It’s in all the guidelines that are recommended on how to treat breast cancer. It helps women decide whether or not they’ll benefit from chemotherapy or not. It’s been a game changer.

Would this also be able to tell you what type of therapy would work best for these men with prostate cancer?

Dr. Klein:  Theoretically genomics will be able to do that but this particular test is not designed to do that. But there are some studies that we’re doing. So for example, radiation therapy is commonly used for prostate cancer but we don’t have a good way of knowing whether or not someone is going to respond to radiation or not. So there are potential signals that we’ve seen that might help tell us that.

Is there anything I’m missing right now?

Dr. Klein: In men who have metastatic cancer genomics at a completely different level than gene expression actually have fueled the development of new kinds of targeted therapy for all sorts of cancers and will do so for prostate cancer also. So this kind of ability to look at the genes and the genomics and so forth is a very, very powerful tool across the whole spectrum of cancer. Not only for prostate cancer but for others and it’s really going to change the face of what we do.

Do you think it’s going to be something that all cancers will be able to look in to not just for breast and prostate?

Dr. Klein:   Yes, absolutely. This particular company also has a test on the market for colon cancer. They have some interesting data that was developed here on kidney cancer and other companies are doing other sorts of things. There isn’t a clinical trial for this now so this test is commercially available now. And it’s available to any doctor ,but it’s mostly for urologists. If a patient is interested in this they should go to the General Health. Com website and read about it, ask the urologist about it. If they decide that they want to do the test the urologist’s office will enter the order at the company’s website. The company will contact the pathologist that has the biopsy slides and get that and then report back to the urologist. All they have to do is ask.

But let’s say you’re five years in to your diagnosis would you get a new biopsy?

Dr. Klein: Yes and you could do this test on the new biopsy to determine if things have changed from the beginning.

FOR MORE INFORMATION, PLEASE CONTACT:

Andrea Pacetti
Cleveland Clinic
pacetta@ccf.org
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