How Genes May Someday Guide Your Prostate Cancer Treatment

Focusing on genetics to personalize your therapy
How Genes May Someday Guide Your Prostate Cancer Treatment

If you have prostate cancer, you likely know there are certain treatments doctors use for most patients. But researchers are working toward more personalized therapies.

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Typically, if you have localized cancer, doctors may choose to monitor the cancer’s status, but defer treatment for a time, or treat with surgery or radiation. If the cancer has spread outside the prostate, androgen deprivation therapy (ADT) is often the first choice.

This deprives the tumor of androgens, which are male sex hormones. An androgen is like fuel for the fire that is the cancer. Doctors typically use ADT to fight the disease when it has become more advanced and this treatment almost always works initially.

The search for more effective treatment

However, ADT isn’t effective in the long-term because cancer cells eventually find a way to produce their own androgens. It may take months or it could take a few years, but the cancer eventually returns.

“It really goes to show you how many ways tumors can outsmart the treatment that we give to them,” says medical oncologist Nima Sharifi, MD.

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In recent research, Dr. Sharifi and his colleagues found that the effectiveness of ADT is shortened for those who have a specific variant of a specific gene — the HSD3B1 gene.

As Dr. Sharifi explains, men have two copies of this gene — one from each parent. Some men inherit the normal version of this gene, some get the variant gene from one parent and others get it from both parents. Researchers discovered that patients who have the gene from both parents are more likely to have their prostate cancer recur sooner.

“This is really a huge step toward personalizing therapies,” Dr. Sharifi says. He says doctors are likely to rely on genetics to guide treatment in the future.

“If you compare a tumor from one patient to a tumor from a different patient, the genetics, which is what drives tumor progression, are quite different,” he says.

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“Two prostate cancers from two different men are not the same. They’re different diseases,” he says. “As a result, what we need to do is to begin to dissect how they’re different. That would give us biomarkers, which can then guide treatment.”

Using genetics to fight tumors

Dr. Sharifi and others are studying patients with the HSD3B1 genetic variant. The trial is testing new treatments to reverse this “bad” biology. He anticipates moving beyond a one-size-fits-all treatment approach.

“What we’re working toward is personalizing treatments, figuring out how individual patients’ genetics drives clinical behavior, and what treatment we should use to counter that behavior,” he says.


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