Looking to Identify High-Risk Men Early
Some men are diagnosed with small, low-risk prostate cancers and choose expectant management. “However, some of these low-risk cancers may harbor molecular or other very subtle features of an aggressive cancer,” says Robert Veltri, Ph.D., Associate Professor of Urology and Director of the Fisher Biomarker and Repository Laboratory at the Johns Hopkins University School of Medicine. “If these men could be identified early, we could eradicate their cancer when the disease burden is low.”
The red flags that signal more aggressive disease early on are extremely tiny, for example, subtle shape and size changes to the nucleus within the cancer cell, or differences in the levels of specific cancer-related proteins. Veltri, working with Brady urologists Alan Partin, M.D., Ph.D., and Ballentine Carter, M.D., and renowned pathologist Jonathan I. Epstein, M.D., has used highly sophisticated methods to analyze very small prostate biopsy tissue samples for ways of identifying men who appear to have more aggressive disease. What he’s looking for, in research funded by the Early Detection Research Network of the National Cancer Institute and a Department of Defense grant, is a “signature” of aggressive disease that can be spotted at a diagnostic biopsy. In a recent study, Veltri analyzed biopsy samples from 70 men on active surveillance who turned out to have aggressive cancer, and from 70 men who had mild, slow-growing disease, and came up with a preliminary test panel that will require validation.
“We have developed an integrated, quantitative histomorphometric and molecular biomarker-based predictor for the early detection of clinically very aggressive prostate cancer,” he says. The preliminary results were reported at the annual American Association for Cancer Research’s annual meeting San Diego in 2014.