Surveillance Network Aids Prostate Research

Up to 50% of men diagnosed with prostate cancer have a form of the disease that grows so slowly that it's unlikely to ever threaten their health if left untreated. Unfortunately, physicians currently have no precise way to determine which patients can forego treatment.

“We need to find out whether a tumor is a wolf in sheep's clothing or if it's really a sheep,” says Stuart Holden, MD, director of Cedars-Sinai's Louis Warschaw Prostate Cancer Center in Los Angeles, CA, and medical director for the Prostate Cancer Foundation, a philanthropic organization that funds research on the disease.

Thanks to a $5-million grant from the foundation, researchers from Johns Hopkins Medicine in Baltimore, MD, and colleagues at Cedars-Sinai have launched the National Proactive Surveillance Network (NPSN), a repository of patient information that will advance understanding of who needs treatment. Patients at the 2 institutions who are diagnosed with early-stage, low-volume prostate cancer will be invited to join the program; other institutions will be added to the network in mid- to late 2013.

Patients pursuing proactive surveillance defer treatments such as surgery and radiation therapy. Instead, they are closely monitored with physical exams and medical tests every 6 months and a prostate biopsy every year. If cancer progresses, they may opt for treatment. This strategy is also called active surveillance, expectant management, or watchful waiting.

Participants regularly complete detailed lifestyle and nutrition questionnaires, and their blood and urine samples and biopsy tissue are banked in the repository, says H. Ballentine Carter, MD, director of Adult Urology at Johns Hopkins. Prostatectomy tissue is collected from participants who decide to have surgery.

Investigators will analyze the samples and correlate their findings with the clinical data. Such work might lead to the discovery of genetic signatures of aggressive disease, for example, or allow researchers to examine the activity of circulating tumor cells at different disease stages.

Since 1995, Johns Hopkins urologists and oncologists have gathered clinical data on more than 1,000 patients pursuing proactive surveillance for prostate cancer, the largest prospective cohort in the country, notes Carter. Many of those patients will enroll in NPSN. Holden says the Cedars-Sinai team aims to further enrich the data by enrolling about 100 more patients annually.

“If we can figure out who has disease that really needs to be treated,” he adds, “we will have solved a huge problem.”

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