Prostate cancer care in Asia prepares to enter era of genomics
Prostate cancer care in Asia is about to enter the era of genomics as related research in the region is currently in full swing.
“Despite high ethnic similarities, the incidence rates of prostate cancer in Japan, South Korea and Singapore have been much higher than the rate in China,” said Dr Zengnan Mo of the Guangxi Medical University, Nanning, Guangxi, China. “The tremendous difference may be explained by the availability of prostate-specific antigen [PSA] screening programmes in Japan, South Korea and Singapore, as compared with only seven cities in China. Differences in lifestyles and economies may also play a role.”
“Most studies on prostate cancer screening were performed in Caucasian populations. It remains unclear whether implementation of prostate cancer screening programmes would translate into a reduction in prostate cancer mortality in Asia,” he continued. “Four prostate cancer screening trials have been started in Asia, but the data are currently immature for analysis.”
Apart from PSA levels, single nucleotide polymorphisms (SNPs) may also be useful in predicting prostate cancer risk.
“Numerous efforts have been made in the past few years in identifying genetic loci and SNPs from genome-wide association studies [GWAS] in Asian populations,” said Mo. “For example, a group of Chinese researchers found two new prostate cancer risk loci at 9q31.2 and 19q13.4 in the Chinese population. Two susceptibility loci for prostate cancer at 11p15.4 and 14q23.2 were identified in a large meta-analysis of two GWAS in Japanese and Chinese populations.” [Nat Genet 2012;44:1231-1235; Nat Commun 2015;6:8469]
“SNPs associated with prostate cancer risk can be used to calculate a genetic risk score [GRS], which, together with family history and high penetration mutations [HPMs], can predict an individual’s genetic susceptibility to prostate cancer,” he added. “GRS and HPMs can also predict prostate cancer survival.”
Personalized medicine in prostate cancer has always focused on management of advanced disease. Recent research has shown that its potential may be far broader, encompassing the entire spectrum of cancer care. “In 2016, a group of prostate cancer experts proposed a new model for prostate cancer care. It incorporates a genomic-based approach into all levels of prostate cancer care, from prevention and screening to diagnosis and treatment of early-stage and late-stage disease,” said Mo. [Asian J Androl 2016;18:505-508]
“In response to the new approach, we have initiated a large-scale study to evaluate the effectiveness of incorporating genomic-based care in the screening, diagnosis, and early-stage and late-stage treatment of prostate cancer in China,” said Mo. “The study will recruit 50,000 healthy Chinese men in the screening cohort, 20,000 men with elevated PSA levels in the diagnosis and biopsy cohort, 10,000 patients with localized prostate cancer in the early-stage treatment cohort, and 4,000 patients with advanced prostate cancer in the late-stage treatment cohort.”