In the August 15 issue of Clinical Cancer Research, the researchers report that "Stat5" protein in the nucleus of prostate cancer cells was a significant predictor of which patients would develop a worrisome recurrence years after their prostate cancer was initially treated. Stat5 is a protein that, when activated, signals cancer cells to continually grow and survive. The study investigated prostate cancer biopsies or prostate cancer tissues obtained from surgery from 357 prostate cancer patients, and matched active Stat5 levels with outcome.
Given further validation, the findings offer hope that a "biomarker" can be developed to help oncologists and urologists to identify patients that are more likely to have a recurring and/or eventually life-threatening prostate cancer. Specifically, these patients with potentially aggressive prostate cancer should be actively treated and closely monitored in contrast to men with less aggressive prostate cancer who may safely choose "watchful waiting," especially if they are elderly, the researchers say.
Sorting out the few aggressive prostate tumors from the many that are indolent is a problem that has plagued the treatment of prostate cancer, said Marja Nevalainen, M.D., Ph.D., assistant professor in the Department of Oncology at Lombardi Comprehensive Cancer Center and principal investigator of the study.
"Most patients diagnosed with prostate cancer have slow-growing tumors that don't need aggressive therapy, but doctors do not have a way to identify the few men whose cancer is potentially dangerous. The result is that many patients are over-treated," she said.
"If future studies with Stat5 continue to show that it can help in predicting disease outcome, then we can test tumor biopsy samples for Stat5 and tailor treatment accordingly," Nevalainen said.
In the study, Georgetown researchers found that patients with "mid-grade" tumors who had high levels of activated Stat5 in their prostate cancer cells were 1.7 times more likely to experience disease progression compared to patients without activated Stat5. That corresponds to a 15-year, progression-free survival of 46 percent versus 62 percent, respectively.
"Mid-grade tumors are the most difficult to predict for the clinical outcome, said Nevalainen, "therefore, the most immediate use of Stat5 in prostate cancer as a marker would be for identification of the subgroup of mid-grade prostate cancers that are likely to progress early to androgen-independence and metastatic disease" said Nevalainen. "We feel that patients in this group who test positive for activated Stat5 should not remain treated with watchful waiting only, but should be actively and extensively treated."
When biopsy samples from all the patients in the study were analyzed and Stat5 readings were compared to their outcome, those with activated Stat5 had a progression-free survival rate of 44 percent, compared to 65 percent in patients whose cancer was free of activated Stat5.
These findings are the latest in a series of studies led by Nevalainen highlighting the role of Stat5 in prostate cancer development.
Among Nevalainen's earlier findings:
- Stat5 protein is particularly plentiful in the most aggressive prostate cancers, which have often spread by the time they are diagnosed.
- Stat5 can be experimentally inhibited - active Stat5 protein can be stopped before it reaches the DNA of the cell and triggers growth. This research has led to work to develop a pharmacological agent for human use. "There are only few treatment options available for advanced prostate cancer now, and we hope that we can develop a drug that might offer hope for patients with aggressive prostate cancer in the future," she said.
GUMC co-authors include first author Hongzhen Li, M.D., Ph.D., Edmund Gehan, Ph.D., Ying Zhang, M.S., and Edward Gelmann, M.D.; Andrew Glass, M.D., from the Center for Health Research at Kaiser Permanente Northwest in Portland, Oregon; and Tobias Zellweger, M.D., and Lukas Bubendorf, M.D., from the University of Basel in Switzerland. The study was funded by American Cancer Society and Department of Defense Prostate Cancer Program.
Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through our partnership with MedStar Health). Our mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis--or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, and the world renowned Lombardi Comprehensive Cancer Center.