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Five types of prostate cancer identified

Cancer Research UK scientists have for the first time identified that there are five distinct types of prostate cancer and found a way to distinguish between them, according to a landmark study published in EbioMedicine.

The findings could have important implications for how doctors treat prostate cancer in the future, by identifying tumours that are more likely to grow and spread aggressively through the body.

The researchers, from the Cancer Research UK Cambridge Instituteand Addenbrooke’s Hospital, studied samples of healthy and cancerous prostate tissue from more than 250 men. By looking for abnormal chromosomes and measuring the activity of 100 different genes linked to the disease they were able to group the tumours into five distinct types, each with a characteristic genetic fingerprint.

This analysis was better at predicting which cancers were likely to be the most aggressive than the tests currently used by doctors – including the PSA test and Gleason score – but the findings need to be confirmed in clinical trials with larger groups of men.

Professor Malcolm Mason, Cancer Research UK’s prostate cancer expert, said: “The challenge in treating prostate cancer is that it can either behave like a pussycat – growing slowly and unlikely to cause problems in a man's lifetime – or a tiger – spreading aggressively and requiring urgent treatment. But at the moment we have no reliable way to distinguish them. This means that some men may get treatment they don’t need, causing unnecessary side effects, while others might benefit from more intensive treatment.

“This research could be game-changing if the results hold up in larger clinical trials and could give us better information to guide each man’s treatment – even helping us to choose between treatments for men with aggressive cancers. Ultimately this could mean more effective treatment for the men who need it, helping to save more lives and improve the quality of life for many thousands of men with prostate cancer.”

Prostate cancer is the most common cancer in men in the UK, with around 41,700 cases diagnosed every year. There are around 10,800 deaths from the disease each year in the UK.

Vincent Gnanapragasam, consultant urological surgeon at the University of Cambridge and Addenbrookes Hospital, and Clinical Adviser to Check4Cancer, comments: “Although preliminary, these results are very promising. The first step, however, is still initial diagnosis of the cancer.

For detecting at an early stage new tests based on refinements of the PSA have shown particular promise not only for detection but also suggesting how aggressive a cancer might be. One example of this is the 4K score which has been tested in many hundreds of men and has shown to significantly reduce the false negatives and false positives of PSA testing alone. Test like the 4Kscore can give a far more accurate indication of whether a patient should be taken to the biopsy stage.

It’s at this point that we hope this new research may ultimately provide us with better means of analysing the cancerous tissue to identify the most effective treatment.”

In the UK The 4Kscore is not yet generally available on the NHS, where PSA testing remains standard, but Check4Cancer offer the test to the private and corporate markets through ProstateCheck.

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