Professor Hubert Hondermarck and his research team are identifying the key difference between aggressive prostate cancer tumours and less aggressive, indolent ones, so that the treatment can be dialled up or down accordingly.

Professor Hubert Hondermarck and his research team are identifying the key difference between aggressive prostate cancer tumours and less aggressive, indolent ones.

It all comes down to nerve infiltration, meaning that the nerves surrounding the solid tumour grow into the mass, fuelling its growth.

Professor Hondermarck and his team have also discovered that the tumours attract the nerves by emitting a substance called nerve growth factor (NGF).

Professor Hondermarck says that these two factors combined – NGF molecules attracting nerves, and nerves infiltrating the cancer – are what make the cancer metastasise into its more aggressive form.

While prostate cancer is generally one of the less fatal forms of cancer – the problem comes with the ‘broad brushstrokes’ approach to diagnosis and treatment.

At the moment it’s hard to tell the difference between an aggressive and an indolent tumour at the time of diagnosis.

The diagnosis process involves a blood test called a prostate-specific antigen test (PSA) that is looking for biomarkers of prostate cancer.

Incidentally, the foundations for this test were pioneered by Professor Jim Denham, a University of Newcastle and HMRI researcher.

The standard procedure, if cancer is discovered, is a biopsy which is painful for the patient, and then a suite of treatments that can include surgery, radiotherapy and hormone therapy.

The negative side effects of this approach include impotence and incontinence.

What Professor Hondermarck is hoping to achieve is a diagnostic process that can tell the difference between killer tumours and the less harmful ones so that the treatment can be dialled up or down accordingly.

He says, “It’s not uncommon to find prostate cancer during autopsies. The person in question didn’t die of it – it was just present – which suggests that many people can live without symptoms or complications from indolent tumours, potentially for many years.”

When you consider that all men aged over 50 years have a hypertrophic prostate, meaning that they are susceptible to prostate cancer, the need to be able to tell the difference between the types of tumours that kill you and the ones that have minimal impact becomes a healthcare imperative.

The next step for improving diagnosis would involve the use of Magnetic Resonance Imaging (MRI) to scan the tumours to identify nerve infiltration.

After that, it involves identifying what type of nerves are growing in the tumour – ie sensory nerves, sympathetic and parasympathetic nerves, etc.

The goal of the research is to be able to better detect the presence of nerves in tumours using non-invasive methods (MRI) and identify what kind of nerves they are, in order to use targeted drug therapies that work on the correct nerve type.

Targeted drug therapies (precision medicine) will be applied to inhibit the activity and growth of nerves – especially before the tumours have a chance to invade the bones.

Sadly, it’s very common for aggressive prostate cancers to move into bones which is not only very painful for patients – it’s often a death sentence.

One form of drug therapy that can already be safely used to decrease the activity of sympathetic nerves is beta blockers. They inhibit the nerve growth and lower associated anxiety for patients – all with minimal side effects.

The overarching goal of this research is not only to save as many patients as possible. It’s also about avoiding unnecessary treatment because the side effects are so serious.

Professor Hondermarck says this technology – the nerve infiltration identification and subsequent targeted drug therapy – could potentially be applied to all solid tumours, including pancreatic cancer, brain cancer, gastric cancer and potentially colon and breast cancer too.  

Until these innovations become clinically available, Professor Hondermarck has a message for all men aged over 50 years: get a PSA test, available by pathology referral through GPs.

“Men are very lucky to be able to get this done. It’s a very accurate test and while it does detect the presence of all prostate cancers – aggressive and the less dangerous ones – the key to successful treatment is early diagnosis before the cancer metastasises into the bones,” said Professor Hondermarck