The epigenetics revolution: How epigenetics has changed our understanding of prostate cancer and can be applied to improve patient management

International Conference on Prostate Cancer

June 22-24, 2015 Florida, USA

Leander Van Neste

Posters-Accepted Abstracts: J Cancer Sci Ther

Abstract :

Besides being the most common cancer in men, prostate cancer is heavily debated because of patient management issues. Since the adoption of PSA testing for routine screening and diagnostic purposes, many men have been diagnosed through the use of this molecular marker, however, at the cost of over-diagnosis and over-treatment. Recent reports of the PLCO (US) and ERSPC (Europe) trials indicate that prostate cancer screening by means of PSA has only a modest effect on mortality. However, men in the control group could still have undergone a PSA test that eventually led to the prostate cancer diagnosis. Strikingly, but not unexpected, over 75% of all the biopsies were false positive and of those men that were identified with prostate cancer, the majority were early stage (I or II) and low Gleason score (6). Epigenetics in general and DNA methylation in particular has been shown to play a crucial role in the onset and progression of cancer. DNA-methylation biomarkers are actively used to improve patient management and avoid unnecessary repeat biopsies and potential over-treatment of patients. The utility of DNA-methylation markers goes much further and could eventually find application in predicting which men are at increased risk of harboring occult cancer whether a man has aggressive cancer or whether he could go on to active surveillance or such markers could be used for early stage screening purposes in non-invasive sources. A single marker or set of markers is unlikely to result in an absolutely correct prediction. Hence, the most optimal solution would be to combine the strengths of different types of markers and to strive for the largest complementarity and synergy. The relative weight of the markers can be done based on their individual and proven value as interpreted by experts or this could be mathematically modeled leading to a more uniform decision making process and better patient management.