| RADICAL PROSTATECTOMY DATABASE
- YEAR 3 Supporting - New Markers for Prostate Cancer Jonathan Cohen, Dr M Constance Parkinson, Dr John Masters Prostate Cancer Research Centre |
Introduction - Providing New Markers for Prostate Cancer
Early prostate cancer can be treated with radical surgery or radical radiotherapy. Alternatively, if the cancer is not expected to cause symptoms during the lifetime of the patient, it is carefully followed and only if the PSA rises is treatment given. The decision as to which route to take is partly guesswork, and is based on the characteristics of the cancer and the preferences of the patient and the clinician. So it is clear that new markers are needed which accurately predict the optimum treatment for men with early prostate cancer, so that treatment decisions can be made with a greater knowledge of the likely benefits of each possible type of treatment. To find such markers, the history of a large series of cases with a long follow up is needed. The radical prostatectomy database is providing the tissue and clinical information required in the search for new markers.
About the Radical Prostatectomy Database
The database provides clinical information on the symptoms, microscopic appearance and outcome of radical prostatectomy, the surgical removal of the prostate gland for the treatment of early localised prostate cancer.
It is by far the largest and longest (currently up to 13 years follow up) group of radical prostatectomy specimens collected in the UK.
It records detailed information on the diagnosis, surgery and follow up of all the patients whose surgical specimen was sent to histopathologist Dr Connie Parkinson for microscopic assessment.
The database will provide the foundation for the next decade of research into prostate cancer.
Progress Report 2001
In 2001 the number of new cases is projected at 175 (3 cases per week), and to date (October 2001) the total number of cases in the database is 900.
The database now has preoperative PSA levels on over 95% of cases (compared to <80% at the end of 2000), and the recording of postoperative PSA levels has risen in real terms by 150 cases from 300 last year to over 450 to date.
Pathological Staging has been added as a data item to the database as a formal identifier of prostate cancer severity to bring the study in line with current systems of classification.
A considerable amount of work has been done this year in recording GP details, referring to hospital details and a discharge trail on patients, in order to support the follow up process. The database now has a free text field to record any further clinical/pathological/logisticaI details about patients.
Over the year regular requests have been received for numbers of cases and subgroups for analytical and/or research purposes. This is the main reason for having the database.
Recent requests include:
• Histopathology study (Dr M C Parkinson): Identifying the scope of the study and data completeness
• Molecular Pathology (Dr Magali Williamson et al): A preliminary series of cases have been identified for this study.
• Post radical biopsies (Dr M C Parkinson and Simon Bott).
• PSA negative cancers (Dr Stephen Harland - this is the Prostate Research Campaign supported project G2001/10)
The future
New Case Input
In order to maintain a large series of cases to support statistically robust research, new cases are continually added to the study and the database is growing at approximately 16% per annum. The number of cases added in 2002 is projected to be 200 (4 cases per week) and at this rate of growth the database will exceed 1000 cases in the first quarter of 2002.
Tracking Case Outcome and Follow up
Most men do very well following radical prostatectomy, and the majority of the men in the database are alive and having regular PSA monitoring, so the information in the database needs continual updating in order to trace the outcomes of treatment over the long term.
Collecting all the information for the database is an enormously time consuming and labour intensive task, since the study involves up to 10 different surgeons operating on multiple NHS and Private sector sites, making casenote retrieval and patient follow up complex. Furthermore patients are often discharged back to their GP or local hospital for ongoing PSA testing, and additional work is needed to contact GPs where relevant.
Supporting Clinical and Biological Research
Information from the database will provide the samples for ongoing research. The maintenance of such a large series will ensure that there are enough samples to provide appropriate control groups.
The first goal will be to look for genetic changes in the cancers from two groups of patients, those who do well following the operation and those who do badly. Dr Magali Williamson, Lecturer in Molecular Cell Biology and Mr Manit Arya and Mr Simon Bott, Clinical Fellows and Urology Registrars, will extract DNA from the cancers of these two groups of patients to look for changes which predict the behaviour of the cancer.
Jonathan Cohen and Dr M Constance Parkinson are also using the database to analyse systematically all the microscopic features of the 900+ specimens, comparing the diagnostic needle biopsies taken before the operation with the appearance of the radical prostatectomy specimens. Again the aim of this work is to look for features in the diagnostic biopsies which indicate the likely benefit of radical prostatectomy.
There is an additional task in contacting patients themselves to gain consent in 2002, to comply with standards recommended by the UCL/UCH Research Ethics Committees.
Research report summarised by Prostate Research Campaign UK, 03
March 2006
Project 2001/12