How Aggressive is my Prostate Cancer?

The latest genomic tests for prostate cancer, including Prolaris (Myriad Genetics) allow urologists to make an assessment of how agggressive the cancer is likely to be. This in turn helps the doctors to recommend highly personalised care and structured treatment regimens that are entirely appropriate according the individual patient's genes.

The Prolaris prostate cancer test has been "validated" in its ability to predict disease-specific death in the largest study of its kind and is now starting to be used by some urology centres. However, it is still early days and more work is needed to establish clinical utility in the more routine setting.


Levels of Threat from Prostate Cancer vary widely from Patient to Patient

According to the latest available prostate cancer statistics from Cancer Research UK there are over 400,000 new cases of prostate cancer diagnosed a year, and the latest death rates for prostate cancer are around 100,000 a year in Europe. In the UK around 110 new patients are diagnosed a day, with prostate cancer being the most common form of cancer in men and responsible for around 30 deaths a day.Prostate Cancer Cells

Around 75% of prostate cancer deaths are recorded in men over the age of 75 but due to improved medical diagnostics and treatments eight out of ten patients will now survive their prostate cancer for longer than five years.

Prostate Cancer Cells under the microscope (pictured right)

Measuring Prostate Cancer Aggressiveness

The critical factor with regard to prostate cancer is that these cancers vary considerably between different patients in their level of threat or aggressiveness and this is is mostly down to a factor known as 'Cell Proliferation' or 'Cell Cycle Proliferation (CCP)'. Up until recently it has been difficult for urologists to accurately measure the tumour cell proliferation and this can be problematic. There are a range of treatment options and clearly those more aggressive tumours showing higher rates of cell proliferation require more aggressive treatment.
Equally most men given the required prognostic information would prefer to avoid surgery and the risks associated with surgery if possible.

Testing Prostate Cancer at the Cell and Molecular Level

The screening  and diagnostic value of the PSA (prostate specific antigen) test has been questioned extensively. The key issue is that there is no one PSA reading that can be considered 'normal', and the test is not specific for prostate cancer. This is fundamental. For example, PSA levels can become elevated following a bicycle ride. In the context of cancer the name prostate-specific antigen is a bit of a mis-nomer and this causes confusion. Just because you might have a relatively high PSA level does not necessarily mean that you have prostate cancer. Equally, you may have prostate cancer, but still have a relatively low PSA.

If there are diagnostic limitations for the role of PSA, it's role as a prognostic marker once prostate cancer has been diagnosed is even further restricted.

Therefore the challenge for effectively managing clinically localised prostate cancer is to first of all establish the level of cancer aggression especially as cell proliferation rates vary widely from patient to patient. What is needed is a prostate cancer proliferation test that provides an accurate indication of the level of threat.

Prostate Cancer Proliferation Test - Prolaris

As a direct result of this clinical challenge, a new genomic test has been devloped that measures prostate cancer cell proliferation. The new genetic test,called Prolaris, is designed to measure cell proliferation and therefore more accurately predict cancer aggressiveness. The Prolaris test is still used in conjunction with PSA and Gleason score and is not meant to be a substitute, even though it is probably now the single most significant prognostic test at the time of diagnosis.

Detecting Genes that Express the Level of Cancer Aggression

The molecular biology of each patient is different and so Prolaris is the first prognostic test to be able to measure the level of expressed genes that are known to be involved in prostate cancer cell proliferation.  The level of 'risk stratification' provided by Prolaris enables the urologist to better predict each individual patient's likelihood of disease progression within ten years. In this way a better, personalised treatment and/or monitoring plan can be recommended.
Prolaris can also be used following surgery (post-proctatectomy) to better establish the risk of recurrence and to inform the nature of follow-up and treatments.
Contact Prostate Cancer, Urologists - see Mr Andrew Ballaro Consultant Profile
A substance that prompts the immune system to fight infection with antibodies. Full medical glossary
Abnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. Full medical glossary
The basic unit of all living organisms. Full medical glossary
The process of determining which condition a patient may have. Full medical glossary
The basic unit of genetic material carried on chromosomes. Full medical glossary
Relating to the genes, the basic units of genetic material. Full medical glossary
A system used to assess the extent of abnormality of prostate cancer cells. Full medical glossary
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The surgical removal of the entire prostate gland. Full medical glossary
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