In the US, September is National Prostate Cancer Awareness Month. This feature highlights why catching prostate cancer early can be important, and what researchers are doing to improve the management of the disease once it’s detected.
Prostate cancer is a paradox. It has one of the highest early-stage survival rates of any cancer, yet it is the second most common cause of cancer death in the US among people with prostate cancer (after only lung cancer). Localized prostate cancer, found only in one part of your body, is highly curable. But once it becomes metastatic, spreading beyond the salivary glands, it is incurable and leads to death.
This makes learning it complicated. How do you understand something that is once simple and impossible to cure? Researchers addressing the paradox are harnessing technologies such as imaging, genomics, big data, and artificial intelligence to work toward transformative outcomes for patients in all forms of cancer. From understanding what makes cancer grow in the first place to identifying new drugs and new treatments—each innovation is an opportunity to save lives. Here’s a look at some of the countless projects underway around the world that could one day change the treatment landscape for prostate cancer.
Limiting paradox
The ten-year life expectancy for localized prostate cancer is around 98 percent. He is concerned about healing. Many prostate tumors are slow-growing and non-threatening, they don’t even treat them—they’re only monitored to make sure they’re not dangerous. Dr. Isla Garraway, director of research at the Department of Urology at the University of California, Los Angeles (UCLA), said: “You are more likely to die from prostate cancer than from prostate cancer.”
But once the cancer becomes metastatic, that prognosis changes completely. Treatments can improve the patient’s quality of life and prolong their life, but eventually the cancer will become resistant to all treatments and will become fatal. According to Dr. Yaw Nyame, a attending physician and assistant professor of urology at the University of Washington, said: “For most prostate cancers, when we diagnose it because you have a sign of disease, it is usually a sign that his illness is very advanced. If you have pain, or blood in the urine, or difficulty emptying your bladder, you probably have advanced disease.” In other words, the risk is increased by the fact that you are not to the symptoms until it is too late to heal.
Meanwhile, the prevalence of the disease is staggering. About 1 in 8 people with prostate cancer (depending on who you ask) will be diagnosed in their lifetime. So in 2021The US has seen roughly 248,530 new cases and about 34,130 deaths.
Estimates of the percentage of metastatic cancers run from 5 to 10 percent, but the large number of general cases means that even a low-end estimate will mean a lot of cancer that resists treatment. We had CDC says the percentage is increasing, which means that it is more important than ever for science to solve the problem of incurable metastatic prostate cancer.
Understanding the causes
“For cancer researchers in general, we’re always looking for initiatives. Where does it start, what cells does it start in, how does it coordinate the processes of normal cells to avoid the immune system or invade areas where it shouldn’t?” says UCLA’s Dr. Garraway. “Like other cancers, the whole idea is to understand the biology of prostate tumors well so that you can find the Achilles heel of that tumor.”
The challenge, Garraway told Ars, is that for too long, research into what causes prostate cancer has focused on the indolent (or slow-moving) parts of the disease that are treatable. More surgeries remove slow-growing tumors, leaving researchers with more access to these tissue samples. Metastatic patients are unlikely to undergo surgery because their cancers have spread to other parts of their body, so those diagnoses are very rare.
“For the 10 percent or so that are determined to have this metastatic disease, at least half of them have spread and their cancer is diagnosed,” he said. “They’re not candidates for surgery, so we don’t take colors themselves. And it’s a challenge to get enough tissue from a metastatic lesion.”
Recent advances in technology have changed that fact. In the last decade, Garraway said next-gen biological process technology has allowed scientists to distinguish and analyze very small physical values. Doctors can now use a tiny needle to remove “a very small piece of tissue,” creating a paradigm shift in the diagnosis of deadly prostate cancer.
Looking at prostate cells
It is now possible to ask if there are factors that mark high-risk tumors early. Garraway compared these small samples of metastatic tumor cells to non-cancerous prostate tissue, hoping they might provide a clue to the cause of the former’s aggressive behavior.
You do this through focus on the egg stem normally found in the prostate, which can give rise to any type of cell in this tissue (although, unlike embryonic stem cells, they cannot give rise to any. other tissues). But the cells will appear in prostate tumors, too. Garraway hypothesized that specific prostate stem cells may have features that make tumors more dangerous. Comparing the genes active in prostate stem cells and cancers “gives us clues about how these more aggressive cancers are producing prostate cancer markers.” The embryo-type properties can facilitate infestation and spread,” he said.
Because prostate cells can generate new glands, they are very good at moving around and attacking other parts of the body. “And they’re tougher. They can survive things that differentiated cells can’t survive,” Garraway said. “They are resistant to radiation and chemotherapy, and can survive damage to their DNA. We think that the activation of these survival mechanisms supports tumor initiation.”
Prostate blood, with green and red dots identifying the presence of proteins found in stem cells.
Garraway and his colleagues took samples of healthy prostate tissue, sorted the cells by the different proteins they produced, and identified if the cells had characteristics such as the ability to regenerate prostate tissue. The results were compared to those generated using stem cells found in metastatic tumor samples. “This is where it hurts,” Garraway said. It turns out that both normal and tumor cells express a protein called Keratin 13. That protein is very rare in most healthy tissues, but, “we almost always find (it) in the biopsies with metastatic disease,” he said.
Before this, researchers thought that Keratin 13 was what Garraway called the “run of the mill” protein that was easy to give cell shape and hardness. But they know some keratin can also play a role in the signal needed when cells are released. “So right now what we’re focused on is what you can do,” Garraway told Ars. They are started by removing Keratin 13, which results in the cells becoming weak. “We isolated cells that expressed Keratin 13 could no longer balance. It was suggested that it has a functional role in the metastatic process.”
This research is still in very early stages. Garraway called it “an example of how we’re doing research and discovery, but it shouldn’t be considered a powerful new medical treatment right now.”
Even if it doesn’t lead to treatments, the research he and his colleagues are doing will still contribute to the general science of prostate cancer. “Our biggest focus is to understand the tumor biology of these aggressive cells,” he told Ars. “Metastatic prostate cancer is incurable. We have to understand who and why and how.”