October 31, 2014
 
prostate cancer discovery  
   THE BRADY UROLOGICAL INSTITUTE • JOHNS HOPKINS MEDICINE

   A PUBLICATION OF THE PATRICK C . WALSH PROSTATE CANCER RESEARCH FUND
   Volume VI, Winter 2011
 
Will My Gleason Score Get Higher?
 

   
 

Maybe you’re one of the lucky ones, with a low Gleason grade and a small tumor volume, and your prostate cancer is considered “low-risk” enough that you are eligible for active surveillance. (For more on active surveillance, see story.) You’ll be closely watched. But wouldn’t it be helpful to know if your Gleason score was likely to remain the same, or whether it might go up? Epidemiologist Bruce Trock, Ph.D., thinks so. He is the principal investigator on a grant from the National Cancer Institute to look for biomarkers that can help predict what will happen with a man’s Gleason score. “Right now, the ability to safely offer active surveillance as an alternative to immediate treatment depends on the biopsy,” he says, “and how well it can characterize the aggressiveness of the tumor in the entire prostate.” With active surveillance as an option being chosen by more men who are diagnosed with a low Gleason grade, doctors need to know more, Trock adds: “We need to be able to predict the possibility of unsuspected high-grade tumor for these men. This is an important clinical problem.”

In this new study, scientists at Hopkins, the Mayo Clinic, Memorial Sloan Kettering Cancer Center, the Fred Hutchinson Cancer Research Center, and the UCLA Cancer Center, are evaluating more than 30 biomarkers, hoping that several of these, used together, will be able to predict the presence of high-grade tumor in men whose biopsies show only low-grade cancer. “If we are successful, this study could change the way treatment decisions are made in men with low-grade cancer on biopsy who are considering active surveillance,” Trock notes, “and help reduce the over-treatment of prostate cancer.”

Prostate Cancer Pathology Resource Network
In other research, Trock is also the principal investigator of a grant from the Department of Defense’s Prostate Cancer Research Program to explore a variety of biomarkers for several uses, including early detection of prostate cancer, determining individualized therapy, and predicting how aggressive cancer will be, or whether it needs to be treated at all. Although many biomarkers have been studied in recent years, none has become a major presence in any of these aspects of diagnosing and treating prostate cancer. One reason for this “lack of translation” to clinical use, says Trock, “is that results are often inconsistent among studies of the same biomarker.” And this is because these results often come from fairly small, retrospective studies that use tissue samples that are not representative of the disease, and non-standardized methods. Also, he adds, scientists don’t fully understand how the way tissue is handled and processed before it is analyzed can affect the biomarker findings.

“ This network…will speed the
clinical translation of biomarker
research, understanding of tumor
biology and the impact of prostate
cancer genetics on risk.”

The Department of Defense Prostate Cancer Pathology Resource Network, established with this grant, is a major step toward correcting these problems and advancing translation of biomarker research, Trock says. Johns Hopkins will lead a network of centers that will conduct research to define optimal, standardized protocols for important classes of biomarkers, and use these protocols to provide high-quality biospecimens. “This network will provide a tremendous resource for prostate cancer researchers, and will speed the clinical translation of biomarker research, understanding of tumor biology and the impact of prostate cancer genetics on risk.”

   


 

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