Prostate cancers can run, but they can no longer hide. For the first time, researchers have found a way to target individual prostate cancer sites in other parts of the body. We take a look at the science behind this headline-grabbing story and ask if it lives up to the media fanfare. *Spoiler alert: for the most part, we think it actually does.
The Telegraph hailed this as a new ‘prostate cancer breakthrough’. The BBC said it ‘points the way to targeted drugs’, and The Independent said ‘nine out of ten men with advanced prostate cancer…could soon be treated. And the good news is that when you strip away that media hype, this is still a piece of research worth getting excited about.
The story, in a nutshell, is that an international team of scientists examined the genetic material from 150 men with advanced prostate cancer. They looked at the men’s normal DNA, the DNA in their prostate cancer and – for the first time – the DNA in the bits of their prostate cancer that had spread outside the prostate and set up camp elsewhere in the body (metastatic tumours).
Before we even get to the results of this in-depth look at all this DNA, we can already get excited about the fact that this is the first time doctors have been able to get hold of tissue samples from metastatic tumours in men living with advanced prostate cancer. This is important because it means doctors will one day be able to use the information they get from these samples to determine the course of treatment for each individual patient.
This research went on to show just how important this new tissue sampling technique will be. The DNA inside cancer cells often contains changes, or mutations, which can affect how they behave – how fast they grow, how well they move or how they react to various drugs, for example. When they examined the prostate cancer DNA from the original cancer, and it’s spin-off tumours, the researchers found that in general, the metastatic tumours carried more, and often different, mutations than the original prostate tumour, which opens up new possibilities for treating advanced disease.
Even better, scientists won’t need to develop new drugs against most of these mutations, because in many cases, the drugs already exist and are either in use, or in clinical trials, for other cancer types.
You may have heard this research called prostate cancer’s Rosetta Stone. Professor Johann de Bono, Professor of Experimental Cancer Medicine at The Institute of Cancer Research, London, and Consultant at The Royal Marsden NHS Foundation Trust, explains: “We have for the first time produced a comprehensive genetic map of the mutations in prostate cancers that have spread round the body. This map will guide our future treatment and trials for this group of different lethal diseases. We’re describing this study as prostate cancer’s Rosetta Stone because of the ability it gives us to decode the complexity of the disease, and to translate the results into personalised treatment plans for patients.
“Our study shines new light on the genetics of prostate cancer as it develops and spreads – revealing it to be not a single disease, but many diseases each driven by their own set of mutations. What’s hugely encouraging is that many of the key mutations we have identified are ones that can be targeted by existing cancer drugs - meaning that we could be entering a new era of personalised cancer treatment.”
Our Director of Research, Dr Iain Frame, added: “This is incredibly exciting and ground breaking research. It suggests for the first time the list of genetic mutations to search for in order to build up a blueprint of a man’s prostate cancer once it has spread. This could provide the information about the best routes of attack in each individual case which is crucial if we are to reduce the number of men dying needlessly from this disease.”
This is an excellent piece of research, and the benefits it could bring to men with advanced prostate cancer may be immense. But we’re not there yet. Dr Frame went on to say: “The next step is to confirm whether those drugs would have the same impact if used to target those mutations when found in prostate cancer. If so, this could greatly increase the range of treatments for advanced prostate cancer and, crucially, enable clinicians to select with greater confidence those which are going to work best for each man.”
There’s still a lot of work to do before we know whether this could become a routine part of advanced prostate cancer treatment. We need to find out whether the drugs that work in other cancer types work the same way in prostate cancer, and whether you’d need to use a combination of drugs in cases where men have more than one type of mutation. In which case what combinations are most effective and still safe to use? And we need to work out whether it’s really of benefit to use drugs that will treat the metastatic tumour, while potentially leaving the primary tumour alone.
Even taking into account the time saved by not having to develop new drugs, these answers won’t come quickly. And once we’ve got them, it will take a bit more time to get these new treatment approaches approved for routine use on the NHS.
So while research like this does take us huge leaps forward, there is still a long way to go. But we’ll be supporting the continuation of this research through its ongoing work with the Movember Centre of Excellence based at the ICR, so this definitely isn’t the last you’ll hear from us on this story.
This month, together with the Movember Foundation, we’re announcing over £2 million of funding for innovative and exciting research projects that we believe will one day help improve the lives of men with prostate cancer. These awards aim to help get established and promising projects get over the line and give scientists with innovative ideas a head start. Find out more.