Spotlight on prostate cancer

As we near the end of March, Prostate Cancer Awareness Month is in full swing in the UK to raise awareness of prostate cancer. Here at BMC Medicine, we take a look at some of the latest advances in prostate cancer research and treatment as we launch our new Spotlight on prostate cancer article collection, guest edited by Sigrid Carlsson and Andrew Vickers.

Prostate cancer is responsible for over 300,000 deaths every year, and is the second most common cancer type in men worldwide. The causes of prostate cancer are not fully established, but African-Caribbean race, older age, and family history are known to be risk factors.

Is diet linked to prostate cancer?

Diet is also thought to be associated with prostate cancer risk. In a review article published in BMC Medicine as part of our Spotlight on prostate cancer collection, Pao-Hwa Lin and colleagues discuss recent evidence for the role of diet in prostate cancer incidence and progression. The authors highlight that that although some findings are inconsistent, consuming a healthy diet is a promising approach for prostate cancer prevention.

…one of the biggest problems we face is that current diagnostic techniques cannot differentiate between those cancers that will go on to kill and those that may never cause any harm. As a result, we currently do not have a robust screening programme for clinically significant prostate cancer

Dr Iain Frame
Director of Research at Prostate Cancer UK

Detection and screening

The incidence of prostate cancer has increased dramatically in the last two decades, which is mainly attributed to the increased availability of screening.

Prostate-specific antigen (PSA) screening for prostate cancer remains very controversial, and the risk:benefit ratio of regular testing is not fully established. In a commentary article, Eric Kim and Gerald Andriole explore the guideline recommendations for PSA screening across countries, highlighting that recommendations vary widely by organization.

For example, the European Association of Urology recommends invitation to screening at any age where life expectancy is greater than 10 years, whereas the U.S. Preventive Services Task Force recommends against regular screening.

At the recent Prosca15 Global Congress on Prostate Cancer, Stacy Loeb explained that randomized controlled trials on PSA screening have produced contrasting results, and emphasized that we must move from “one-size-fits-all” to a more individualized approach to PSA screening.

We have moved from a “one-size-fits-all” approach in prostate cancer management to multidisciplinary strategies tailored to the individual patient and his specific cancer.

Carlsson and Vickers
BMC Medicine 2015, 13:60

Individualized disease management

Prostate cancer management is also becoming more personalized, and in an editorial to launch our article collection, Guest Editors Sigrid Carlsson and Andrew Vickers explain that disease management is becoming tailored to the individual patient and his specific cancer.

The first genomic classifier to predict the risk of metastasis in prostate cancer has recently been reported. At Prosca15, Jeffrey Karnes explained that genomic tests such as this could help guide treatment decisions in a move towards more individualized disease management.

Therapies: insights from the latest clinical trials

Although there is increasing evidence for the promise of using individual genomic information to guide prostate cancer risk stratification and treatment, such tools are not yet used in routine clinical practice. Men with prostate cancer typically undergo a biopsy, followed by staging and either active surveillance or treatment with radiotherapy, surgery, pharmacological therapy, or a combination of these options.

Recent clinical trials have revealed novel hormonal therapies that substantially increase survival in men with prostate cancer. At Prosca15, Cora Sternberg outlined these trials, explaining that agents such as abiraterone and enzalutamide have led to vast improvements in the treatment of men with prostate cancer, but new clinical and molecular predictors of survival are urgently needed.

Unfortunately, resistance to hormonal therapies often develops. Christopher Evans described some of the mechanisms involved in resistance that could be targeted to combat resistance in the future. Evans discussed early data showing that ARV7 – a splice variant of androgen receptor mRNA found in circulating tumor cells – could be a biomarker of therapy resistance, which could be used in the clinic following further validation.

The role of chemotherapy in prostate cancer treatment

A great deal of progress has been made in the development of new hormonal therapies, but is there a place for chemotherapy in the treatment of prostate cancer? Maria de Santis argued that not all men respond well to hormonal therapy, and docetaxel in particular provides benefits for patients with prostate cancer while being reasonably well-tolerated.

Together, new data presented at Prosca15 emphasized great progress that has been made in moving towards a more individualized approach to prostate cancer management. Many speakers highlighted the need for the development of biomarkers of therapy response, as well as more patient-specific risk profiling and prognostic indicators.

BMC Medicine’s Spotlight on prostate cancer series

Our Spotlight on prostate cancer article collection is now open for submissions, and collection aims to highlight recent progress in all areas of prostate cancer research and treatment. We welcome submissions of research articles covering prostate cancer epidemiology and prevention, screening and risk stratification, disease management and new therapies, biomarkers, molecular genomics and translational studies. The collection also includes invited reviews and commentaries. If you have any research you would like us to consider for inclusion in this article collection, please email us at

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