New test to predict if prostate cancer will come back... and it could save thousands of lives, experts claim
Scientists can predict the chances of prostate cancer returning up to a decade before it does, in a huge potential boost to survival rates.
About half of men who develop local advanced prostate cancer will go on to see the disease return, often with a poor prognosis.
But a new test – which combines genomic sequencing and artificial intelligence (AI) – can identify those most at risk at the point of first diagnosis.
Knowing who is more likely to see the disease return means doctors can treat them more aggressively, giving them the best chance of stopping the cancer from coming back.
Experts believe it could be widely used in as little as three years following larger trials, saving the lives of thousands of men in future.
A new test – which combines genomic sequencing and artificial intelligence (AI) – can identify men most at risk of prostate cancer recurrence when first diagnosed
More than 52,000 men are diagnosed with prostate cancer every year on average in the UK, making it the most common cancer in men. Around 12,000 men die every year from the disease — the equivalent of one every 45 minutes
Prostate cancer is the most common cancer among men and second most deadly, responsible for around 12,000 deaths a year in the UK.
There is no test reliable enough for a national screening programme to detect cases early, meaning survival has stalled.
The disease can be difficult to treat because of its extensive heterogeneity – significant differences between the cancerous cells within each tumour and from patient to patient.
It often develops at more than one site within the prostate producing two or more tumours, making it difficult for clinicians to decide on the best course of treatment.
This can range from a 'watch and wait' approach to radiotherapy, hormone therapy, surgery or a combination of treatments.
Researchers at the Institute of Cancer Research, London and The Royal Marsden NHS Foundation Trust, developed an AI tool to assess biopsies, taken at the point of diagnosis.
They used it to analyse 1,923 samples from 250 patients on an earlier clinical trial, focusing on the spatial tissue structure of the cancer biopsies.
They also used a purpose-built AI technique to perform Gleason grading – a scoring system that grades cancerous tissue from one to five, based on the pattern of its cells.
At the same time, the researchers assessed the genetic differences between the cells within individual tumours, using 642 biopsy samples from 114 participants in the same radiotherapy trial.
This allowed scientists to assess information about both the cells' genomics and morphology at the same time, to see how both affected the chances of it returning.
The long-term nature of the trial meant they were able to analyse these against the patients' outcomes over more than a decade, vital in prostate cancer, which can be slow-growing.
They found that the greater the genetic difference between cells - and the greater the difference between the shape, size, and structure of the cancer cells within a tumour – the higher chance of relapse.
Professor David Dearnaley, Emeritus Professor at the ICR and retired consultant clinical oncologist at The Royal Marsden, said the findings could have a significant impact on patients with traditionally poor prognoses.
'It is potentially really very exciting for the future,' he said.
'We were able to define that the worst 20 per cent of patients really did very badly compared the remainder which is exciting because it means you you've potentially defined the group where you can intensify treatment.
'There are various forms of treatment that are presently possible and if we can improve treatments, we can improve cure rates.
'Until now, we've not been able to separate out the patients who have the very highest risk of recurrence, but our novel analyses could change this by significantly improving our ability to predict whether cancer will return.'
The study, which will be published in Nature later today (Fri), found the more differences between the shape, size and structure of cells, the more likely the cancer was to adapt and survive. This 'evolvability' was therefore a strong predictor of recurrence.
Researchers were also able to identify a subgroup of patients who experienced disease recurrence in half the length of time compared with the rest of the patients.
More than 52,000 men are diagnosed with prostate cancer every year in the UK and 299,000 in the US
There was also a correlation between the loss of a specific chromosome and a reduced presence of immune cells in the tumour, which may affect response to certain treatments and guide clinical decisions.
Andrea Sottoriva, Professor of Cancer Genomics and Evolution at the ICR at the time of the research who is now based in Milan, Italy, said the findings have 'never been shown before.'
He added: 'By applying a computational approach to multiple datasets, we have been able to decipher some of the dynamics of cancer progression and treatment resistance.
'This type of research is key to furthering our understanding of how and when to treat cancers, including prostate cancer.'
It comes as a landmark prostate cancer screening trial is getting underway in the UK, with a national screening programme likely to follow.
Transform will test the effectiveness of diagnosis techniques including MRIs when compared to the current standard, prostate specific antigen (PSA) blood test.
The Mail has campaigned on improving prostate cancer outcomes for more than two decades.
Researchers will now conduct tests on a larger, more diverse group of men but anticipate technology like this will become routine.
Dr Hayley Luxton, Senior Research Impact & Intelligence Manager at Prostate Cancer UK, said: 'It's devastating to get the news that your prostate cancer has come back after getting the all-clear. As every man's cancer is unique, it's a huge challenge for doctors to predict whether this will happen and to work out the best treatment plan that will prevent it.
'This project is fascinating because the researchers combined evolutionary studies and AI to develop innovative tools that could be used to identify the men whose prostate cancer is likely to return quickly — enabling doctors to combat this by delivering the most effective tailored treatment for those men.'
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