Prostate cancer research: human trials next
A breakthrough in research into No 1 cancer killer of New Zealand men has buoyed this year's Blue September for the University of Otago's Dr Elspeth Gold.
The anatomy department lecturer and prostate cancer researcher and her team are about to begin human trials to test breakthrough treatment for men with aggressive prostate cancer.
The findings, which are being collated for publication, are the byproduct of three years of research out of Gold's medical sciences department lab.
"If we can get really good quality end-stage therapies then there is absolutely no reason that a man need die of it, Gold said.
One in 10 New Zealand men develop prostate cancer and more than 550 die every year.
That's more than the road toll," Gold said.
"It's a biggie. It's a noble goal but that's the big picture stuff that we work with."
The Otago results were exciting, turning up some "very good indications", Gold said.
"We're still at the early stage. We've really just finished proof of concept in cell lines, human tissue arrays, and animal models.
"For example, we work on a factor, protein, increased in prostate cancer, specifically increased in the aggressive form [of prostate cancer], not the early stages.
"When we block that, when we knock it down in cell lines [cells taken from the prostate and grown in the laboratory] we alter the growth characteristics of those cell lines.
"We can alter the characteristics of those cells by modulating the expressions of these proteins and what that's doing is, it's making the cells appear more like normal cells."
Human trials would be conducted over the next couple of years, she said.
"We would hope to be in a situation in two to three years' time that we've got something that works in the population – where we're trying to get clinicians on board to start using it and trying to work out whether it will provide benefit over what's currently used."
No choices of treatments for men with high-grade cancer was available now, Gold said.
"You need to operate fairly quickly to remove the prostate.
"There are certain overt side effects with that. Given the prostate sits below the bladder and all the nerves that control the bladder, and all the nerves that control an erection, run up through that area.
"So, an overt side effect of having the prostate removed is some degree of incontinency and some degree of impotence.
"And then, if the cancer moves out of the prostate, because the prostate is exquisitely regulated by the male hormone, testosterone, what they do is abolish all the male hormones by giving the man a drug or by removing the testicles.
"It's a life-changing procedure."
For now, however, it's the only thing that ends up saving your life.
Gold's work is an extension of seven years of research carried out with Dr Gail Risbridger at Monash University in Melbourne.
Her Otago research team has six members – two staff members, three PhD students, and a Masters student – focusing on different aspects of prostate research.
The highly qualified team members have been wearing blue and running a bake sale within the medical sciences wings every lunchtime to support the country's Blue September initiative, which aims to increase awareness of the disease and to raise money for research.
Gold said they did this every year.
Ironically, her own blue headscarf is covering the effects of the treatment she is having for breast cancer.
Yes, Gold said, her number had come up and she was one of the unlucky ones to get breast cancer. It's under control and surgery would come next, she said, before changing the subject back to her research.
"Prostate cancer is an incredibly significant disease," she says.
"New Zealand and Australia have the highest rates of prostate cancer ... in the world. Maori men are twofold more likely to die from the disease.
"Nobody knows why.
"But if prostate cancer is picked up early while it's still sitting in the prostate there is absolutely no reason that a man need die from it.
"It's an area I can make a significant contribution, too, because unlike other cancers there are no reliable diagnostics for prostate cancer. So we're also looking at a diagnostic test."
A current test for prostate cancer is called PSA – prostate specific antigen – and it is more of a screening tool than a diagnostic. Another test is a digital rectal exam.
"It's uncomfortable, it's embarrassing and many men don't want it done. And that also doesn't tell you whether you've got prostate cancer. It just tells you there are abnormalities in the prostate that we've got to have another look at."