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A 70GENEE XPRESSION ME TA STATIC A SSAY BIOMARKER COULD CHANGE HOW PHYSICIANS DE TERMINE TRE ATMENT PL ANS FOR PATIENTS WITH PROSTATE CANCER. PROSTATE CANCER IS unique in that some t u mors m ay cau se no cl i n ica l symptoms a nd pose little or no risk to a patient 's life. Physicia ns use active sur veilla nce to monitor these tumors, which require further treatment only if they shows sig ns of prog ression. That saves patients from side effects associ- ated with radiation a nd chemotherapy. However, the issue is knowing which tumors a re likely to prog ress at what rate. Current techniques do not a lways make that clear, and if the cancer is more a g g ressive t ha n physicia ns initia l ly deduced, patients may have forfeited the benef its of ea rly, aggressive treatment. A CHANCE TO IMPROVE DIAGNOSIS? D e v e l o p e d a t Q u e e n 's Un i v e r s i t y B e l f a s t , i n No r t h e r n I r e l a n d , t h e meta static a ssay ha s been t he focus of recent studies a imed at improv ing prog nostic a nd diag nostic procedures related to prostate ca ncer. A s t u d y p u b l i s h e d i n E u r o p e a n Urology hy pot hesized t hat t he a ssay " m ay i mpr ove t he a bi l it y t o det e c t patients at risk of metastatic recurrence following radica l prostatectomy." Based on these findings, Suneil Jain, MD, PhD, Senior Lecturer at Queen's Universit y B el fa s t a nd C on s u lt a nt O nc olog i s t at t he B el fa st Tr ust , spea rhea ded a new study. P ubl i shed i n Ann a l s of O n col ogy, this study exa mined the a ssay 's per- forma nce in diag nostic biopsies from patients who had undergone prima r y radiation therapy a nd a ndrogen depri- vation therapy. " T h e c u r r e n t s t u d y s h o w s t h a t patients who were biomarker-positive — even when you considered sta nda rd clinica l va riables — were about three times a s li kely to develop meta static prostate cancer after primary treatment w ith radiation therapy a nd a ndrogen depr ivat ion t herapy," Dr. Ja i n say s. " The rate of metastases-free sur viva l a t 10 y e a r s f r om i n it i a l t r e a t ment wa s 94 percent in patients who were metastatic assay-negative a nd 72 per- cent for patients who were metastatic assay-positive." The assay may enha nce diag nosis of prostate ca ncer's likely aggressiveness if physicia ns ca n test for the bioma rker ea rly, enabling t hem to ma ke a more i n for med decision about whet her to pu r sue a c t ive su r vei l la nce or more agg ressive treatment. AN UNCERTAIN PATH It is too early to say whether metastatic assay will become a common diag nos- tic tool, however. Existing diag nostic procedures include prostate-specif ic a ntigen (PSA) tests a nd g rading t he appea ra nce of prostate ca ncer using a Gleason score. " You're a lways going to have va r i- abilit y for a ny g iven g rade or number of metastases in predicting the actua l sur v iva l a nd response to treatment , but [current methods] a re pretty good," says Ian F. Tannock, MD, PhD, Emeritus P r ofe s s or of M e d i c a l O n c olo g y a t Princess Ma rga ret Ca ncer Centre in Toronto, Onta rio. " The g rade you f ind in a biopsy gives you a reasonable a ngle on a gg ressiveness. If you have a ma n you suspect ha s meta static prostate cancer and his PSA is high, he will have a bone sca n, a nd likely a CT sca n, a nd a biopsy ... a nd that should give you a fa ir bit of information." Dr. Ja in is cautiously optimistic. " We want to pick the right patients for intensif ied treatment," he says. "If we could develop bioma rkers that g ive us more confidence that a cancer was truly indolent , that wou ld help us pick the right patients for active surveillance." ■ BIOMARKER May Shed Light on Prostate Cancer's Aggressiveness BY JOSH GARCIA S P E C I A L C L I N I C A L S E C T I O N : M E N ' S H E A LT H ❰❰❰❰❰ 0 7 M D N E W S . C O M /// M D N E W S N O R T H W E S T O H I O ■ 2 019 0 7

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