Yesterdays Wall Street Journal publish a very important piece by Melinda Beck in their Health Journal ( . Everyone should go to the piece and read it. The piece, The Prostate Cancer Quandary, has received some play in the prostate community, but its real importance to us has not yet been recognized by our community experts.

The piece opens stating that “Scientists may soon be able to answer the agonizing question facing men with prostate cancer: Does their cancer need immediate treatment or can it be left alone?” Implicit in the article, but not addressed in the opening, is that the research it goes on to discuss has the potential of not only helping men to decide if treatment is needed, it also has the potential of directing doctors to use only treatments that will work. Today, we use the old standby, the shotgun approach to prostate cancer treatment. We put drugs into men and wait and see if they work. More often they do not.

I have said many times that prostate cancer (like all other cancers) is not one single disease. Prostate cancer is actually multiple diseases, but we just have not been able to distinguish one from the other. Now, the research discussed by Ms. Beck, has shown that we have moved many miles in the journey of recognizing the different types of prostate cancer. We are not at the end of the journey, far from it, but we have started the trip and we have made good progress in a short time period.

The key to the trip has been our increasing understanding of the genetic code. We have only recently completed the mapping of the human genome. Now we are mapping our diseases. We have learned to compare the genomic structure of a healthy person to the genomic structure of a sick individual. We have begun to recognize all the way down to individual gene differences between the healthy and the sick individual. More importantly, we have begun to see that there are different gene modifications within each disease, or different types of prostate cancer.

“Several recent genetic discoveries could help doctors evaluate how aggressive a man’s prostate cancer is much earlier. Scientists at the University of Michigan have identified at least 24 different kinds of prostate cancer of varying virulence whose DNA signatures can be read like a bar code. Memorial Sloan-Kettering Cancer Center researchers have identified other genetic subtypes of prostate cancer that seem to predict whether the tumor will be low or high risk. And Harvard Medical School scientists have found a specific gene that causes prostate cancers to spread. Some of the discoveries also could lead to new treatments, tailored specifically for the kind of prostate tumor a man has.”

The pivotal comment is that “Some of the discoveries also could lead to new treatments, tailored specifically for the kind of prostate tumor a man has.” This is big and this is very important. Understanding the different “types” of prostate cancer will allow the development of specific treatments, treatments that will only work for a person with that genetic disorder, but it will work. No more need use the shot gun approach which so often reeks havoc on a person’s life.

“Scientists say new prostate-cancer tests could be available in the not-too-distant future. It won’t be tomorrow, but if you go by the pace at which such technology entered the field of breast cancer, it will be several years

[for new prostate tests], not a decade,” says Charles Sawyers, chairman of human oncology and pathogenesis at Memorial Sloan-Kettering.” This is good news as I didn’t realize that we were even as advanced as the article has indicated. I did hear references to some of these findings at the recent American Association of Cancer Researchers (AACR) and the American Society of Clinical Oncology (ASCO) conferences, but I had no indication that the work was as progressed.

The potential for all of us, both currently diagnosed and the not yet diagnosed, is monumental. We need to continue to fund and encourage additional development in this area. I am sure that we are going to find that there are even more genetically distinct types of prostate cancer then has yet been defined, but all I can say is, bring it on.

Joel T Nowak, MA, MSW