Thousands of men with high-risk prostate cancer could benefit from longer lives after researchers identified a genetic test that may help doctors determine who needs the most intensive treatment.
Prostate cancer is now the most common cancer among men, with about 64,000 new cases diagnosed each year in the UK alone.
However, doctors face a difficult challenge: identifying the patients most likely to benefit from aggressive treatment while avoiding potentially debilitating side-effects in men who may gain little from it.
Research has found that adding the hormone therapy abiraterone to standard treatment can halve the risk of death from prostate cancer in some men with the disease.
Abiraterone works by blocking testosterone production. The drug was introduced on the NHS in England earlier this year after already being adopted in Wales and Scotland.
But doctors currently lack a reliable way to identify which patients are most likely to benefit. As a result, some men may face side-effects such as fatigue, liver damage and urinary tract infections without receiving significant additional benefit.
Experts at University College London (UCL) now say a test that examines tumour tissue taken during an earlier biopsy or operation could help doctors pinpoint the patients most likely to respond to the treatment.
“Abiraterone saves lives, but we may currently be over-treating some patients with this therapy,” Dr Sarah Howlett, the study’s lead author, told the Daily Mail.
“With this test, we can identify which patients need the treatment most and avoid it for those who do not, giving doctors a clearer idea of which patients face the highest risk of their cancer returning.”
Findings from the STAMPEDE trial suggest that the test, known as Decipher, can identify the men most likely to respond to hormone therapy.
The research, presented at the European Society for Medical Oncology Congress in Madrid, analysed data from more than 30,000 men.
Decipher examines the activity of 22 genes in tumour tissue to estimate how aggressive a patient’s prostate cancer is.
Because the analysis uses tissue already collected during a biopsy or prostate operation, patients do not need to undergo an additional procedure.
The test produces a score ranging from 0 to 1. A higher score indicates a greater risk that the cancer will spread or return following treatment.
By contrast, men with lower scores may be less likely to need more intensive treatment.
The researchers found that higher Decipher scores consistently predicted poorer outcomes.
The Daily Mail is campaigning to end needless prostate cancer deaths and supporting screening for men at high risk of the disease
For every 0.1-point increase in the Decipher score, the risk of cancer spreading to distant organs was 49 per cent higher, while the risk of dying from prostate cancer rose by 38 per cent.
The researchers concluded that the test could help doctors direct intensive treatment towards the men who need it most, while sparing others unnecessary side-effects.
“For men with very high-risk prostate cancer, preventing the disease from spreading is critical. Understanding who is most likely to benefit from additional treatment can make a meaningful difference,” Dr Howlett said.
‘Our findings suggest that a genomic test could help personalise treatment: men with high-risk disease but a low Decipher score have low rates of cancer spread and could potentially be spared more intensive treatment, while men with a high score could be prioritised for it.’
However, she cautioned that larger studies are still needed before the test can be routinely used to inform treatment decisions.
Elai Davicioni, medical director at Veracyte, which makes the Decipher test, added: ‘We believe this growing evidence gives physicians a stronger reason to use Decipher before making decisions that can affect both cancer outcomes and patients’ quality of life.’