One of the terms we hear in the world of cancer is precision medicine. In the area of prostate cancer what does this really mean?
Precision medicine is a very broad term, but it can be better described as looking at an individual man’s genetic code and the genetic code of their tumors for the purpose of making treatment decisions. These genetic codes dictate both aggressiveness of the disease as well as the potential efficacy of a drug or treatment.
Prostate cancer is a very heterogeneous disease; often each tumor contains multiple genetic structures. In addition, as the tumor spreads to other parts of the body, it will continue to mutate and develop additional different genetic structures.
This is why we say that prostate cancer is not one disease, but it is many, based on its genetic structure. It also means that prostate cancer is ever morphing, or a constantly changing target, as it progresses and mutates!
In addition to the genetic mutations of the tumors, individual men metabolize drugs differently, thus the ability of a drug to be effective will also vary from man to man. Even with drugs that are effective, their optimum doses will vary depending upon the underlying genetics of the man.
In prostate cancer precision medicine is, in reality, a moving target as the tumors grow and continue to mutate. Completely successful prostate cancer precision medicine, that might bring about an actual cure, would require our being able to identify 100% of all the mutations as well as understanding a man’s underlying genetic code (for drug metabolism purposes).
This goal sounds like a pretty talland unreachable order, but we might not really need to reach it. If, over time, we can identify a man’s underlying genetic code as well as also identify enough of the genetic mutations in the tumors, we might actually control enough of the disease so that a man with prostate cancer will be able to live long enough and with a good quality of life to die from some other unrelated cause.