Individually, the pathological capacity of the course of prostate cancer also varies remarkably from one person to the next. In some cases, it happens quickly; for others, it moves more slowly and leads to a better prognosis. Prediction of how prostate cancer’s growth may be important to personalize treatment strategies and eventually improve treatment outcomes. While medical researchers have developed numerous new methods to help physicians in making such predictions, one of the most promising seems to be the count of circulating tumor cells (CTCs) in oncologic blood samples.
The spread of metastatic prostate cancer is through cancerous cells breaking away from the original tumor and traveling via the bloodstream around the body. These cancer cells-CTC-are not anchored to vessel walls. The count of CTCs within a blood sample provides reference in staging cancer and freezing a cancer track. This test, sometimes known as a liquid biopsy, is very enticing because it allows the physician to avoid a great deal of invasive experimentation and answer what will be the standard chemotherapy dose or perhaps something a little more aggressive on the patient.
Circulating Tumor Cells in Prostate Cancer
So far, the only one test for CTCs in prostate cancer patients is CellSearch, usually for such men who have progressed beyond non-response to hormonal therapy for metastatic prostate cancer.Hormone therapies usually directly suppress testosterone inside the body. This hormone fuels the cell growth in prostate cancer. In case hormonal treatment fails to show any positive response in the cancer’s specific conditions, the chances of worse state are often accompanied by high numbers of CTCs in the blood.
Recent research has extended the knowledge that CTC count can predict the level of disease progression in early-stage metastatic prostate cancer in men; disease progression occurs in men who still respond to hormonal therapy. This is key in that it empowers cancer caregivers to take the most informed treatment action given the anticipated behavior of cancer. The patient population to participate in more aggressive options due to rapid progression would be more favorable options, such as more advanced drug combinations or participation in clinical trials. Those patients who are older and sick might not always tolerate more aggressive treatments.
Materials and Methods
In a study performed recently, researchers were able to work with blood samples from 503 such men who had recently been diagnosed with hormonally-sensitive metastatic prostate cancer, and who all were brought into clinical trials studying new hormonal therapies. The samples were drawn exactly after patients were admitted to the clinical trials and then again, after progression from the treatments they were receiving.
CTC count was analyzed in both the samples and then divided the results into three groups:
Five CTCs or more per 7.5 mL of blood.
One to four CTCs per 7.5 mL of blood.
No CTCs at all in 7.5 mL of blood.
Their objective was to establish an interpretation of how CTC load associated with prognosis and disease progression.
The key findings from the research,
This indicated that the number of patients with a higher CTC count to have the worst outcomes. Men with more than 5 CTCs to the patient average had a survival median of only 27.9 months, as against 56.2 months for 1-4 CTCs. The effect of zero CTCs could not be calculated in men since there was no single case of patient death among them.
Furthermore, higher CTC counts were responsible for the early resistance to hormonal therapies in men. Therefore, the average of 11.3 months required resistance in men with higher CTC counts as compared to their counterparts with 1 to 4 CTCs and 59 per month would be required. This is a demonstration that not only can CTC levels be used to predict survival, these are also predictive of the speed a patient’s cancer would become resistant to treatment.
The presence of higher CTC count had been linked with a more severe course of prostate cancer. Men with several CTCs had higher PSA values, hiher bone metastases, as well as other indicators of a more symptomatic and obvious metastatic disease.
What This Means for Patients
The research is clear. Using CTCs is going to be more important for the prostate cancer patient than ever before. As a prostate cancer expert, Marc Garnick, MD, says, “Here are the implications of CTCs for outcomes and relatable clinical decisions in metastatic prostate cancer research.”
There is an added advantage of CTCs over biopsies in that they—”doctors today will do almost anything to avoid putting a needle in the patient”—one study suggested the use of CTCs in their place. These researchers advocate noninvasive blood draws, rather than more expensive, risky, or painful methods, to better control the process and allow for more rapid reconfiguration of treatment protocols.
“One test is good when differentiating him or her from the other in this regard,” says David Einstein, a medical oncologist at Harvard Medical School. “What it is really required to do now is to find new biomarkers indicating he or she might have been a different candidate for the most effective treatment.” This discrepancy will bring some change into the field of cancer treatment, as the individual response to therapy will be studied.
However, according to both experts, we require further probing, especially via randomized clinical trials, so that a comprehensive understanding of how CTC counts can be integrated into routine practice can be obtained. Thus, the value of CTC detection has yet to be fully realized since, until the conclusion of full-scale, randomized clinical trials, decision-making based on this diagnostic technology will take a limited form, as it is more rational for the managing clinicians to give treatment and prediction of the disease prognosis their imprimatur until then.
Look into the future
The course of prostate cancer care is changing at this point, and CTC testing is apparently one of such developments. As the understanding of how circulating tumor cells intertwine with the malignant disease process becomes better, more personalized and ultimately more efficient treatment strategies are forecast to come. With a view on what this might mean for men with metastatic prostate cancer, this research might be hopeful in making it so that doctors can predict more precisely the trajectory of the disease-related ideas, incorporate the disease into better treatment strategy, and secure a better quality of life for these patients in the end.