We have heard for a period of time that the future of cancer treatment is in genetics. Despite the hubbub, we see very little hard evidence of this in today’s current treatment decisions. Treatment still remains tied into protocols with a strong bias to following a common map. Each map does have little variances, but they still follow a common direction despite the fact that we do know there are many different types of prostate cancers, all which do behave differently.

Some recent research hints at the potential that genetic knowledge could bring to the future of treatment decisions.

ADT is an important treatment for men with advanced prostate cancer, understanding it is vital. The results and effectiveness of ADT are highly variable from man to man, or prostate cancer to prostate cancer.

Yang, M etal. hypothesized that genetic variants of androgen transporter genes, SLCO2B1 and SLCO1B3, may determine time to progression on ADT. So they took a cohort of 538 men with prostate cancer who had been treated with ADT and genotyped them for SLCO2B1 and SLCO1B3 single nucleotide polymorphisms (SNP). The biologic function of a SLCO2B1 coding SNP in transporting androgen was examined through biochemical assays.

They found that three SNPs in SLCO2B1 were associated with time to progression (TTP) on ADT (P < .05). 1- The differences in median TTP for each of these polymorphisms were about 10 months. The SLCO2B1 genotype, which allows more efficient import of androgen, enhances cell growth and is associated with a shorter TTP on ADT. 2- Men carrying both SLCO2B1 and SLCO1B3 genotypes, which import androgens more efficiently, exhibited a median 2-year shorter TTP on ADT, demonstrating a gene-gene interaction (P(interaction) = .041). So, what does this mean to the value of genetics to the treatment of prostate cancer? The research indicates that by evaluating a man’s genome we can begin to predict his drug response. As we become more sophisticated and experienced we should be able to look at the genetics and determine what treatments might be effective for each individual. This knowledge will allow us to not waste time and money on ineffective treatments as well as allowing men to avoid unnecessary side effects with no potential positive return. Yang M, Xie W, Mostaghel E, Nakabayashi M, Werner L, Sun T, Pomerantz M, Freedman M, Ross R, Regan M, Sharifi N, Figg WD, Balk S, Brown M, Taplin ME, Oh WK, Lee GS, Kantoff PW. Reference: J Clin Oncol. 2011 Jun 20;29(18):2565-73. doi: 10.1200/JCO.2010.31.2405 PubMed Abstract PMID: 21606417 Joel T Nowak, M.A., M.S.W.