Worldwide, prostate cancer is one of the most common male cancers and, by 2030, the number of cases is predicted to grow by more than 60 per cent in the UK alone. The diagnosis and treatment of this disease is both a very distressing experience for patients and families and a significant burden on healthcare systems in every country.

But prostate cancer is very often diagnosed as ‘non-metastatic’, which means that it has not yet spread to other organs. Non-metastatic prostate cancer can also be ‘indolent’, which means that it is unlikely to go on to become life threatening. For men who receive this diagnosis – and their clinicians – the next step is a judgement call about the risk of treatment versus no treatment - and indeed which treatment may be the best choice.

To make the best judgement at this stressful time, it’s critical that clinicians and patients have a reliable way to tell if the cancer is life threatening. Although the risk stratification systems currently used are approved by august bodies - including in the UK by NICE, the National Institute for Health and Care Excellence  - Vincent Gnanapragasam, a lecturer at the University of Cambridge and Consultant Urologist, believes that these tools are fundamentally flawed. Instead of the risk of dying of the disease, these tools were based on the risk of a treatment failing, which are actually two very different things. Moreover, they were largely developed from the outcomes of patients who were treated by surgery, which currently represents only about 15 to 20 per cent of men treated for the disease.

With funding from the Evelyn Trust for a research fellow, Vincent has begun a research project which will develop a personalised – and so more accurate – “prognostic” prediction tool. A prognosis is a clinician’s opinion of whether or not a cancer will go on to prove fatal. Vincent and his team are working to build a model that will predict the individual’s risk of cancer-specific and overall mortality using a large, high quality data set of UK men from the East of England Cancer Registry. They are basing their approach on the pioneering PREDICT model, developed in Cambridge to evaluate personalised prognosis in breast cancer. This should help better inform decisions about who does and does not need treatment - and ultimately improve outcomes for patients.

“It’s vital that the analysis of risk is personalised and so as reliable as possible. To opt for prostate cancer treatment is a life-changing decision because the treatment can have long-term side effects, so it’s not a decision that anyone takes lightly. If we can offer better guidance to patients and clinicians, we will have fewer patients who choose treatment that may not be necessary and suffer as a result,” says Vincent.

The model is now being developed and will be piloted as an online tool embedded in clinics for a trial period and then fully evaluated.

You can find out more about this research at the Cambridge Academic Urology Group on these two websites:

http://www.camurology.org.uk/research/

http://www.cambridgecancercentre.org.uk/users/vjg29