Researchers at the Hutchinson Center have a lead role in a new public/private partnership to create the first systematic surveillance program of men with prostate cancer to look for biological clues to help determine when to wait and when to treat the disease. The Canary Foundation and the National Cancer Institute announced the project on Friday.
Dr. Pete Nelson, of the Clinical Research and Human Biology divisions, will lead the Canary Prostate Consortium. This group of six institutions nationwide will enroll men in a cancer-surveillance study to look for biomarkers—proteins in the blood that could predict prostate-tumor aggressiveness.
The Prostate Active Surveillance Study is meant to help answer a key question that has vexed physicians and researchers: When is it best to treat prostate cancer versus observation or “watchful waiting.” For most men with prostate cancer, the disease never progresses to become a serious health problem, yet most receive some sort of treatment, such as radiation or surgery. Such treatments can have side effects, such as impotence and incontinence, which can be worse than the low-grade cancer. Currently it is challenging to accurately predict when inactive or slow-growing prostate tumors will become aggressive.
“There’s an emerging consensus that we dramatically over treat prostate cancer in general,” Nelson said. “The overall prevalence of the disease in the population far exceeds the number of men whose disease progresses to cause serious problems. Yet, there are clearly many prostate cancers that behave aggressively and patients benefit from treatment. It is a challenging problem.”
In the study, men diagnosed with early stage prostate cancer will not be treated right away but will be closely followed in an active surveillance program involving regular collection of blood and urine samples as well as prostate biopsies. A new repository for blood and DNA samples will be housed at the Center and funded by the Canary Foundation. NCI’s Early Detection Research Network (EDRN), the federal agency that is partnering with the Canary Foundation, will establish disease-specific Common Data Elements, a biospecimen management system and a protocol oversight program. The EDRN data management and coordinating center is based at the Hutchinson Center under the direction of Dr. Zideng Feng of the Public Health Sciences Division.
The samples will be tested for proteins in the blood that can signal when indolent disease has progressed to more aggressive illness. Such biomarkers could help physicians better determine when to initiate treatment versus watchful waiting.
The Canary Foundation is providing initial funding for the Prostate Active Surveillance Study. The five institutions that will enroll patients are University of Washington, Stanford University, University of California at San Francisco, University of British Columbia and University of Texas Health Science Center in San Antonio.
This article has been reprinted from http://www.fhcrc.org/about/pubs/center_news/online/2008/pete_nelson.html. Written by DEAN FORBES.
In 1966, investigators at the University of Chicago won a Nobel Prize for their research on the relationship between male sex hormones, known as androgens, and prostate cancer. Forty years later, researchers are still working out the intricacies of that relationship.
A recent study co-authored by the Center’s Dr. Peter Nelson (pictured left) reports that testosterone-replacement therapy (TRT) for men with low testosterone levels has minimal effect on the prostate gland over a period of six months. Previous studies indicated that this therapy might be harmful.
“It’s pretty well known that androgens are very important for the initiation as well as the progression of prostate cancer. Without any testosterone, prostate cancer essentially never develops,” said Nelson, an investigator in the Human Biology Division. “Eliminating testosterone is the most active form of treatment in very advanced disease. There’s been a lot of interest in studying testosterone in the context of prostate cancer.”
The new study, which was led by Dr. Leonard Marks of the Urological Sciences Research Foundation and the University of California, Los Angeles, was published in the Nov. 15 issue of the Journal of the American Medical Association. Researchers studied 44 men with low serum testosterone levels between the ages of 44 and 78 years. What they anticipated and found was that TRT increased serum testosterone levels to the mid-normal range. More unexpectedly, TRT only slightly increased androgen levels in prostate tissue, and urinary symptoms, which can be affected by growth of prostate tissue, were found to be similar between the placebo and testosterone- treated groups.