UPDATE - Issue 26 - Summer 2006
The Patient's Dilemma
By Mark Feneley
Senior Lecturer in Urological Oncology, UCL
Nobody should have cancer treatment without a confirmed diagnosis. But can the diagnosis be made too early? In the PSA era, a diagnosis of prostate cancer is often made by prostate biopsy before the onset of symptoms. However, not all men with tumours detectable by biopsy would, if untreated, ever develop the symptoms or the life-threatening complications of prostate cancer. Many tumours in the very early stages can exist in relatively quiescent states for long periods of time, and it may be impossible for doctors to be sure that treatment is necessary. But sadly for men who do not have their PSA checked and are eventually diagnosed with cancer, treatment is frequently too late to be curative. This is the patient's dilemma.
Exciting research to change the patient's dilemma is under way (Mark promises an article entitled Breaking the Molecular Code for Prostate Cancer for the next Update). In the very early stages of prostate cancer development, the risk of clinical disease may be a modifiable rather than a constant or inevitable risk. This possibility may enable immediate treatment to be avoided, or safely deferred, according to the level of biological risk. This biological risk relates to a tumour's molecular behaviour, and powerful new techniques are now being developed that may in future provide a 'molecular diagnosis' that identifies the pattern of molecular derangement as a prognostic signature. External factors (dietary, environmental, even medical interventions) are known to induce changes in the prostate that may significantly influence so-called pussy cats to become tigers. Research programmes examining the make-up of developing tumours are vital to refine diagnostic and prognostic tools and to develop techniques for detecting molecular damage to the prostate before 'signatures' of life-threatening disease are irreversibly established.