A team at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust found reading the pattern of genes switched on and off in blood cells could accurately detect which advanced prostate cancers had the worst survival.
And the researchers believe the blood test could eventually be used alongside the existing PSA test at diagnosis to select patients who need immediate treatment.
The test, described in The Lancet Oncology today (Tuesday 9 October), is unique because it assesses changes in the pattern of gene activity in blood cells triggered by a tumour elsewhere in the body.
Study senior author Professor Johann de Bono, leader of the prostate cancer targeted therapy team at The Institute of Cancer Research, London, and honorary consultant at The Royal Marsden NHS Foundation Trust, said: "Prostate cancer is a very diverse disease – some people live with it for years without symptoms but for others it can be aggressive and life-threatening – so it's vital we develop reliable tests to tell the different types apart.
"We've shown it is possible to learn more about prostate cancers by the signs they leave in the blood, allowing us to develop a test that is potentially more accurate than those available now and easier for patients than taking a biopsy. Our test reads the pattern of genetic activity like a barcode, picking up signs that a patient is likely to have a more aggressive cancer. Doctors should then be able to adjust the treatment they give accordingly."
Researchers scanned all the genes present in blood samples from 100 patients with prostate cancer at the ICR's and The Royal Marsden's joint Drug Development Unit in London and The Beatson West of Scotland Cancer Centre in Glasgow. They included 69 patients with advanced cancer and 31 control patients thought to have low-risk, early-stage cancer, who were being managed by active surveillance.
Using statistical modelling, they divided the patients into four groups reflecting their pattern of gene activity – the barcode. When they reviewed all the patients' progress after almost two-and-a-half years, they found patients in one group had survived for significantly less time than patients in the others. Further modelling identified nine key active genes that were shared by all patients in the group.
They confirmed the results in another 70 US patients with advanced cancer, showing that just these nine genes could be used to accurately identify those who ultimately survived for a shorter time - 9.2 months compared with 21.6 months for patients without the gene pattern. The genes included a number involved in the immune system – suggesting the immune system was suppressed in patients whose cancers were spreading around the body.
Professor Alan Ashworth, chief executive of The Institute of Cancer Research, said: "Whether particular genes are active or not is an important clue in identifying patients with a poor prognosis. This latest study shows that it is possible to read these patterns of gene activity like a barcode, allowing scientists to spot cancers that are likely to be more aggressive."
Professor Martin Gore, medical director at The Royal Marsden, said: "Personalised medicine is the future of cancer treatment. This blood test, which reads genetic changes in prostate cancer providing a prediction of how aggressive the cancer might be, is an important development, allowing us to better tailor treatment to suit each individual."The study received funding from AstraZeneca, Prostate Cancer UK (formerly the Prostate Cancer Charity) and the Prostate Cancer Foundation, while the Drug Development Unit also receives funding from Cancer Research UK and the Experimental Cancer Medicine Centre network.
The scientists initially plan to assess the test as part of a large-scale international trial of a new prostate cancer drug in patients with advanced cancer. They also hope to assess the test in patients with earlier-stage disease, using either the existing nine-gene pattern or using the same technique to find another set of genes.
The Institute of Cancer Research, London, is one of the world's most influential cancer research institutes.
Scientists and clinicians at The Institute of Cancer Research (ICR) are working every day to make a real impact on cancer patients' lives. Through its unique partnership with The Royal Marsden and 'bench-to-bedside' approach, the ICR is able to create and deliver results in a way that other institutions cannot. Together the two organisations are rated in the top four cancer centres globally.
The ICR has an outstanding record of achievement dating back more than 100 years. It provided the first convincing evidence that DNA damage is the basic cause of cancer, laying the foundation for the now universally accepted idea that cancer is a genetic disease. Today it leads the world at isolating cancer-related genes and discovering new targeted drugs for personalised cancer treatment.
As a college of the University of London, the ICR provides postgraduate higher education of international distinction. It has charitable status and relies on support from partner organisations, charities and the general public.
The ICR's mission is to make the discoveries that defeat cancer. For more information visit www.icr.ac.uk
The Royal Marsden NHS Foundation TrustThe Royal Marsden opened its doors in 1851 as the world's first hospital dedicated to cancer diagnosis, treatment, research and education. Today, together with its academic partner, The Institute of Cancer Research (ICR), it is the largest and most comprehensive cancer centre in Europe treating over 44,000 patients every year. It is a centre of excellence with an international reputation for groundbreaking research and pioneering the very latest in cancer treatments and technologies. The Royal Marsden also provides community services in the London boroughs of Sutton and Merton and in June 2010, along with the ICR, the Trust launched a new academic partnership with Mount Vernon Cancer Centre in Middlesex.
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