New Developments in Prostate Cancer Biomarkers.

Two articles discussing the development of new genetic tests which could potentially be used to detect and determine aggressive prostate cancers were published in the May 2nd and May 15th  issues of the Zerohour Newsletter of the Project to End Prostate Cancer.

The biggest problem facing men who have been diagnosed with prostate cancer is to determine whether the cancer is potentially aggressive and therefore requires treatment or whether it can be subject to “active surveillance”. PSA values alone will not answer this question. However, genetic changes or biomarkers are being actively sought by researchers to help determine the aggressive nature of the cancer. Three such genes are named ERG, ETV1 and PTEN. Researchers at Stanford University and Abbott Molecular are working to develop a molecular assay to detect rearrangements of the ERG and ETV1 genes and measure loss of the PTEN gene. A study published in the British Journal of Cancer evaluated 308 prostate cancer patients who were treated conservatively. “Those who did not show abnormal ERG/ETV1 genetic changes with no PTEN gene loss had excellent prognosis, as evidenced by an 85 percent survival rate after 11 years. Men who showed PTEN gene loss in the absence of the gene rearrangements had a poor survival rate of 13.7 percent. The study showed the promise of the new biomarkers to identify patients who would benefit most from intensive therapies.”

In another study, researchers at the Mayo Clinic have found that changes to the “on-off” switches of genes occur early in the development of prostate cancer and could be used as biomarkers to detect the disease months or even years earlier than current approaches. “These biomarkers — known as DNA methylation profiles — also can predict if the cancer is going to recur and if that recurrence will remain localized to the prostate or, instead, spread to other organs. The study, published in the journal Clinical Cancer Research, is the first to evaluate the methylation changes that occur across the entire human genome in prostate cancer. The discovery could someday help physicians diagnose prostate cancer earlier and make more effective treatment decisions to improve cure rates and reduce deaths. It also points to the development of new drugs that reverse the DNA methylation changes, turning the “off” switch back “on” and returning the genetic code to its normal, noncancerous state.”

Anxiety-How to Win Our Biggest Battle.

Norwegian Stave church; A. Dalene photo.

I recently met with a well-known urologist whose research focuses on the use of our immune system to combat prostate cancer. In our conversation, I was able to share my own prostate cancer history and current status. He echoed the comment that had been stated by my oncologist and assured me that since there were so many current and future treatment options now available, I would more than likely outlive my own prostate cancer and die of another cause. The urologist went on to state that the biggest problem facing his prostate cancer patients is their own angst. I could certainly echo his sentiment.

In my own case, I had been diagnosed with prostate cancer in 1995. Shortly thereafter, I underwent a successful radical prostatectomy at Johns Hopkins. My cancer was completely localized, had not spread and my Gleason score was an average value of 3+3 or 6. I was an ideal candidate for a “cure”. But the cancer (PSA) returned 7-8 years later and was not completely eradicated by radiation therapy. My PSA doubling time had become 2-3 months, indicating an aggressive cancer. A former colleague of mine had published a paper in a peer-reviewed journal in which he concluded that patients like myself with such a short doubling time could expect an average 5-year survival period. The period of 1995-2004 was filled with lessons I had learned both medically and especially spiritually but it was interspersed with periods of high personal anxiety as recounted in this website (see My Story and Lessons Learned). I am currently asymptomatic and undergoing intermittent therapy. I have continued to pray that God would not allow this disease to take my life and He seems to be reinforcing His answer to me through His word and the predictions of two well-known oncology and urology physicians. God had allowed me to experience this cancer scenario for other reasons, such as that He would be glorified through my experiences and that other men might be encouraged.

I have learned that anxiety can become a bondage and is an individual choice. The apostle Paul states in Philippians 4:6-7 that Christians are to “be anxious for nothing, but in everything by prayer and supplication” (asking), “with thanksgiving, let (y)our requests be made known to God. And the peace of God which surpasses all understanding, will guard (y)our hearts and minds in Christ Jesus.” Worry indicates a lack of trust. I have often worried about the possibility of receiving negative results or news. When the actual results were known, they were never as bad as I had imagined and many times they were very positive. Negative results can serve as tests of our faith. God was showing me that I had a lack of trust and that my own anxiety was a faith battle which indicated that my own faith needed to be re-directed and strengthened. I am to release my anxiety to God and admit that I cannot handle the situation in my own strength. I simply need to trust that God will answer in His way and His time according to His purpose (see Jeremiah 29:11). This will also validate my own personal relationship with God and that it is not simply  intellectual knowledge and mis-placed faith. When we enter into a personal relationship with God, every promise in His Word (such as that above) becomes applicable to us.

Jesus Himself is our greatest example of how to handle anxiety. It is always encouraging to realize that He is both divine and human, and as such can associate with our own feelings. This is best exemplified by Christ’s experience in the Garden of Gethsemane prior to His crucifixion. He had been betrayed and denied by His own friends and disciples. Yet He cast His burden on His Father. First, like us, He prayed that His potential suffering be removed. In Matthew  26:39 He prays for deliverance, “O My Father, if it is possible, let this cup pass from Me.” I am sure any prostate cancer patient can relate to this statement. Then Jesus expresses acceptance stating “nevertheless, not as I will, but as You will.” In verse 42 He prays “O My Father, if this cup cannot pass away from Me unless I drink it, Your will be done.” The fact remains that we who have been diagnosed with prostate cancer must accept its medical reality. But there is better news. Jesus’ third prayer was a desire that God’s grace be seen in Him and that His Father would be glorified. In John 12:27-28, Jesus prays “But for this purpose, I came to this hour. Father, glorify Your name.” As a direct result of our personal relationship with God, we too can cast our burdens and anxiety on the Lord and help others to do so. For me, I often visualize packaging my anxiety in a container and laying it at Jesus’ feet or at the cross. May our deepest desire be that God’s grace and goodness would be seen in us and that He would be glorified in our individual scenarios and outcomes.