NYU DIAGNOSTIC: UTILIZING STEM CELL GENOMIC SIGNATURES TO PREDICT PROGNOSIS IN PROSTATE CANCER PATIENTS

Background:

Prostate cancer is diagnosed in an estimated 80% of men who reach the age of 80 and represents 28% of all male cancers. A heterogeneous disease, prostate cancer ranges from an asymptomatic disease indolent for decades to a rapidly fatal metastatic malignancy. The uncertainty regarding appropriate clinical management of prostate cancer in many patients is related to the fact that similar tumor phenotypes can harbor diverse molecular and genetic changes. Whereas erring on the side of caution with radical prostatectomy or radiation therapy reduces the risk of metastasis, patients’ quality of life can suffer in ways requiring additional clinical consideration, most notably erectile dysfunction, urinary incontinence, and rectal bleeding. In addition, whereas a variety of clinical models have been developed to aid with pre-treatment risk assessment, approximately 20-30% of patients with low to intermediate-risk prostate cancer fail standard treatment as evidenced by rising serum PSA following therapy. Clearly, a better means of stratifying patients, both prior- and post-therapy in terms of good or bad prognosis and concurrent watchful waiting or aggressive therapy is necessary.

Description of Project:

Dr. Wilson has developed a method for stratifying cancer progression, based on the expression of genes unique to adult and fetal prostate stem cell markers, in the tumors of 131 patients drawn from the Memorial Sloan Kettering Cancer Center Prostate Cancer Genomics Data Portal. Overexpression in the tumor of a specific set of genes uniquely up-regulated in adult prostate stem cells has been determined to be an indication of good prognosis requiring watchful waiting. Conversely, overexpression in the tumor of a specific set of genes uniquely up-regulated in fetal prostate stems cells has been found to be an indication of poor prognosis requiring a more aggressive treatment. In addition, whereas limited guidelines currently exist for post-operative treatment for prostate cancer patients with the intermediate Gleason score 7, the set of adult and fetal prostate stem cell specific genes outlined by Dr. Wilson can also be used to stratify these patients for good and bad prognosis.

Application:

This method represents a novel approach to determining prognosis of prostate cancer patients, thereby justifying aggressive treatment in high-risk cases while improving the quality of life for men with indolent disease via watchful waiting. With an accompanying approach to a diagnostic kit containing a set of affinity reagents that specifically detect expression of the various genes, the design of the present invention has tremendous translational implications to improving the accuracy of predicting prognosis and consequent treatment regimen, both prior to and following surgery, in a way which is currently unavailable from the dozen or so diverse and often time-consuming clinical parameters and assays currently in widespread use.

Patent Status:

A provisional patent application covering this novel diagnostic has been filed in the U.S.

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