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Is This Cancer Safe for Active Surveillance?

The ideal candidate for active surveillance is “a man with low-risk disease whose likelihood of progression is low without treatment,” says Misop Han, M.D., the David Hall McConnell Professor in Urology. Still, in case the cancer is more aggressive than it seems, “we follow these men closely, and we recommend treatment if the disease progresses.” Despite its “demonstrated long-term overall safety and effectiveness,” there remains a “what-if” quality to active surveillance. “Active surveillance is not as widely used as it could be, because we have limited ability to accurately assess risk and detect cancer progression. There is a critical need to find accurate biomarkers that can discriminate indolent from potentially lethal prostate cancer.”

One of the most promising biomarkers is one that actually vanishes in aggressive prostate cancer: a tumor suppressor gene called PTEN. From studies led by Hopkins pathologists looking at biopsy tissue and removed prostate specimens after radical prostatectomy, we know that “PTEN is the most commonly inactivated tumor suppressor in prostate cancer,” Han notes. “This PTEN deletion is associated with aggressive clinico-pathologic features and worse prognosis.” Another common genetic change in prostate cancer is rearrangement of a gene called ERG. Together, these two findings make a powerful case for aggressive cancer — the kind of cancer that should not be treated with active surveillance. With pathologist Tamara Lotan, M.D., and support from the Patrick C. Walsh Prostate Cancer Research Fund, Han proposes “to improve the risk stratification of patients in active surveillance by validating PTEN loss/ERG rearrangement as a biomarker to stratify risk, and make sure that men on active surveillance are at very low risk.”

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