Article: Promise of new method to predict prostate cancer

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Researchers have hit upon a promising new way of predicting the outlook of men with prostate cancer – the most common male cancer in the UK.

They say that the size and shape of the blood vessels within the tumour itself can provide important clues as to whether a cancer is so is so slow-growing as to be harmless, or so aggressive it is life-threatening.

This could one day help men decide on the best course of treatment, although more research needs to be done.

What do we know already?

Prostate cancer is common, with about 35,000 men newly diagnosed in the UK each year. It's an unpredictable disease, especially at its early stages. Many tumours grow so slowly they won't cause serious problems in a man's lifetime. But a small number grow more aggressively and can become life-threatening.

Unfortunately, there's no way to know for certain which cancers will grow quickly and which won't. Doctors gain some insight by looking at the cancer cells under a microscope, but this isn't an entirely reliable method. As a result, some men with slow-growing cancers unnecessarily have surgery, radiotherapy, or other treatments. These treatments can cause serious side effects, such as erection problems and incontinence.

Researchers have now explored whether the size and shape of the blood vessels within a prostate tumour might provide additional information about a cancer's nature early on.

What does the new study say?

The researchers found that men whose tumours had small blood vessels were six times more likely to have aggressive cancers or die of their disease than men whose blood vessels were large. And those with the most irregularly shaped vessels were 17 times more likely to develop a life-threatening form of the disease.

The study included 572 men who had been diagnosed with prostate cancer, most at an early stage. All the men had surgery to remove their prostate and were then followed up for 10 years, on average. During this time, 44 developed advanced cancer or died of their disease.

The researchers can't say with certainty why blood vessel size and shape might indicate a cancer's behaviour. But they think that small or irregularly shaped blood vessels may be a sign that a cancer is growing quickly, as the blood vessels haven't had a chance to mature properly.

The researchers also found that men with small or irregularly shaped blood vessels didn't necessarily have cancer cells that looked aggressive under a microscope. This suggests that blood vessels may provide a separate indication of a tumour's nature, providing additional insight into a cancer's future path. This could help men and their doctors decide whether to pursue radiotherapy, surgery, and other aggressive therapies, or to put treatment on hold.

How reliable are the findings?

This study was carefully done and should be fairly reliable. However, only 44 men developed advanced cancer or died of their disease during the study. This isn't a large enough number to draw firm conclusions about the link between blood vessels and life-threatening disease.
Where does the study come from?

The study was done by researchers at US universities and published in the Journal of Clinical Oncology, which is owned by the American Society of Clinical Oncology. It was funded by the US National Cancer Institute.
What does this mean for me?

This study suggests that the size and shape of blood vessels within a prostate tumour may provide valuable clues about the cancer's behaviour. But the research is at an early stage. If you or someone close to you has been diagnosed with prostate cancer, this isn't yet a test you will be offered.

What should I do now?

If you have prostate cancer, your doctor will talk to you about the stage of your cancer and how aggressive it appears under a microscope. He or she will also discuss other factors that can affect your choice of treatment, such as your age and any other health conditions you may have. This can help you can make an informed decision about the best treatment approach for you.
From:

Mucci LA, Powolny A, Giovannucci E, et al. Prospective study of prostate tumor angiogenesis and cancer-specific mortality in the health professionals follow-up study. Journal of Clinical Oncology. Published online 26 October 2009.