Medical treatment is shifting from a traditional symptom-based approach to one that’s personalized for you.
This is especially true for cancer care, where personalized medicine is often the first step in treatment decision-making.
Prostate cancer is among the cancer types most impacted by the personalization of medicine. For prostate cancer, special disease markers are used to decide whether treatment is needed before it even begins.
We’ve partnered with the Prostate Cancer Foundation (PCF) to learn more about how personalized, or precision, medicine is used for prostate cancer.
Precision medicine is used across the spectrum of prostate cancer care, from screening to treatment.
“Precision medicine, or personalized medicine, is an innovative approach to tailoring disease prevention or treatment to account for differences unique to a specific patient or tumor,” explains Dr. Rana McKay, a medical oncologist at the University of California San Diego and PCF-funded researcher.
For example, blood tests that detect a protein known as prostate-specific antigen (PSA) are used to screen for early signs of prostate cancer.
Cancer cells tend to release more PSA than healthy prostate cells, so elevated levels in the blood may suggest that more regular or additional types of testing are needed.
PSA can be high even if you don’t have cancer, though. Observing trends in PSA levels over time is most helpful.
Taking your age and other personal characteristics into account, doctors can understand when a person with high PSA levels may have cancer versus another condition, such as prostate enlargement (benign prostatic hyperplasia) or prostatitis.
The best age to begin screening for prostate cancer can be personalized based on your risk factors. The PCF recommends:
- If you have a strong family history of cancer, start talking with your doctor about screening at age 40.
- If you’re Black, start talking with your doctor about screening at age 40.
- If you don’t have any risk factors, start talking with your doctor about screening at age 45.
The role of precision medicine becomes even more important during treatment. It helps doctors match the right treatment to the exact cancer that you have.
“The goal of precision medicine is to target the right treatments to the right patients at the right time,” McKay says.
“This is important because there are several treatments and clinical trials that are [designed for] people with specific molecular changes in their tumor.”
Oncologists and their teams may consider a variety of factors to evaluate the unique characteristics of a person’s prostate cancer type, such as:
- specific genetic mutations
- how certain genes or proteins are expressed
- how far the cancer has spread
Some types of tests that may be used to evaluate these factors include:
- tissue biopsy
- blood or urine testing
- genetic testing
- imaging, such as PET or CT scans
Results from these tests can help healthcare professionals understand:
- how aggressive the cancer is likely to be
- what kinds of treatment approaches are needed
- which medications will or won’t work against a specific tumor
For instance, tumors that contain mutations in certain DNA damage repair genes may be more likely to respond to a poly adenosine diphosphate-ribose polymerase (PARP) inhibitor, such as rucaparib (Rubraca) or olaparib (Lynparza).
On the other hand, tumors that contain mutations in mismatch repair genes are more likely to respond to pembrolizumab (Keytruda).
Knowing which medication is likely to work for a specific tumor helps doctors avoid treatments that are unlikely to be effective and minimize potentially unpleasant and unnecessary side effects.
Doctors will also consider things like age and other health conditions when tailoring treatment plans to individuals.
For example, prostate cancer is known to be more aggressive and can be fatal when diagnosed in younger men, whereas men over 70 can live with the disease for many years.
However, men who are younger and otherwise healthy have the potential to live for a long time after treatment, which may also influence treatment decisions.
Understanding these factors and taking a personalized approach helps your care team determine how aggressive to be with different cancer therapies.
Personalized medicine relies on doctors finding a specific feature in a person’s tumor that’s known to predict response to a specific treatment.
While many advancements have been made in the field of precision medicine for prostate cancer, there’s a lot left to learn.
Currently, there are only a handful of gene alterations (mutations or abnormalities) in prostate cancer that can help guide clinical decision-making and predict response to treatment.
“However, if we were to actually take all possible alterations that we can target with a drug, the majority of patients likely have a genomic alteration that could potentially be targeted with a specific drug or combination of drugs,” McKay estimates.
A 2015 study reported that samples from almost
The study only included tumor samples from people with advanced prostate cancer. These individuals are at the highest risk of fatal cancer and may benefit a lot from a personalized approach to treatment.
“Lifestyle absolutely plays a tremendous role in prostate cancer treatment and also overcoming side effects of therapy,” says McKay.
Understanding how certain genetic features affect the likelihood that a person will develop prostate cancer can help them take steps to prevent cancer from developing in the first place.
For example, it’s known that diet and physical activity affect your chances of developing prostate cancer. These could be factored into a personalized prevention plan.
During treatment for prostate cancer, lifestyle plans tailored to individuals could someday help people deal with different responses to therapy and side effects.
While research hasn’t yet advanced to the point that a personalized lifestyle plan can be used to help prevent or treat prostate cancer, such a future may not be far off.
Research on precision medicine for prostate cancer is continually growing.
McKay notes that there are many exciting studies on treatments, biomarkers, imaging, and other approaches on the horizon.
She’s particularly excited about the PREDICT study through the Alliance for Clinical Trials, which will launch in January of 2023.
“This is a novel phase 2 biomarker-based umbrella study that uses DNA and RNA tumor profiling to guide therapy selection,” she explains.
There are several other areas of prostate cancer research that one day will be used to guide personalized treatment approaches. Some of the remaining questions
- When can active surveillance be used versus active therapy?
- Who should get surgery versus radiation?
- Who will benefit from more intense treatment?
- Is drug resistance likely to occur?
- What other alterations can be targeted with new or emerging treatments?
McKay adds that having enough people from diverse backgrounds to conduct studies is what helps advance prostate cancer research and the field of precision medicine.
“Participation in clinical research is really paramount for helping optimize treatment for patients,” she says.
Prostate cancer care has been revolutionized by a personalized approach to treatment.
These advancements can help improve outcomes, reduce the occurrence of unnecessary side effects, and set people on the path to recovery sooner.
If you or a loved one has prostate cancer, your doctor should discuss the testing options available to help guide your personalized treatment decision-making.
“It’s important to engage with your healthcare clinicians to optimize treatment and ensure the best outcomes,” recommends McKay.