'Cinderella cancer' comes in from the cold

DaVinci surgical robot Image copyright AP
Image caption Professor Neil Burnet uses the DaVinci robot to perform prostate surgery

It's a sobering thought for all us carriers of the Y chromosome, but prostate cancer kills almost as many men every year as breast cancer does women.

According to Cancer Research UK some 41, 000 men are diagnosed with prostate cancer every year, but 10,700 will die of the disease, making it the fourth most common cause of cancer death - and second only to lung cancer in men.

Given such a dire prognosis, and let's face it, given the financial profile of its victims, you might be forgiven for assuming that prostate cancer would be one of the most highly prioritised and well researched areas of oncology. Not a bit of it. Perhaps it's because men are squeamish, or don't like to talk about their health or visit the doctor, but prostate cancer has long been dubbed "the Cinderella cancer".

"We just don't make enough of it" according to consultant oncologist Professor Neil Burnet. "On the whole men are less vocal about their health, and older men tend to be even more stoical, preferring to grin and bear it. But it means men are poor advocates, and as a result prostate cancer has been overlooked".

Based at Addenbrooke's Hospital on the outskirts of Cambridge, Prof Burnet is trying to improve the targeting and efficiency of radiotherapy treatments, and to reduce toxicity in the healthy tissue surrounding the prostate. The technique, called Image Guided Intensity Modulated Radiotherapy Treatment uses imaging provided by a CT scan to target the tumour before a powerful but precisely shaped radiation dose is administered.

"What limits what we can do with radiotherapy are the side effects of the treatment, the toxicity. And, since the prostate can move by up to a couple of centimetres from one day to the next, targeting the treatment is really important. The second half of this technology is in delivering intensity modulated radiotherapy, which allows us to match a higher dose of radiation to the shape of the tumour."

But if Image Guided IMRT offers the prospect of better outcomes for men with advanced or aggressive prostate cancer, how much better might it be to get in at an earlier stage?

That - at least in part - was the motivation behind the Collaborative Oncological Gene/Environment Study, or COGES, which has announced the discovery of 80 new genetic markers for breast, ovarian and prostate cancer. In one of the largest research projects of its kind scientists from Cambridge University and the Institute of Cancer Research in London looked at samples from more than 200,000 people - half with, and half without, cancer.

The results include 23 new gene variants associated with prostate cancer and 16 with aggressive forms of the disease. Initially at least that should help with the development of a viable screening test for the disease. In the longer term it may present new targets for drug treatment and better diagnosis, and a greater understanding of the mechanisms and basic biology of prostate cancer.

Image copyright SPL
Image caption Two prostate cancer cells seen in the final stage of cell division

"It's shocking, but we still don't have an adequate screening test for prostate cancer," says Ros Eeles, Professor of Oncogenetics at the Institute of Cancer Research and COGES study leader on prostate cancer. "That's because the Prostate Specific Antigen, or PSA test, just isn't accurate enough and you'd have to treat between 12 and 48 men unnecessarily to save a single life. With this new information we could have a viable test in five to eight years".

If that still seems a long way off, surgical techniques have advanced dramatically when it comes to prostate cancer. These days consultant urologist Professor David Neal uses the DaVinci surgical robot to perform prostate surgery.

Sitting at a computer console that looks like it would be more at home in an amusement arcade than an operating theatre, Prof Neal can perform a prostatectomy without ever touching his patient. And because the robotic arms of the device (which looks a little like a crab hovering over the operating table) are much thinner than the surgeon's, and the grappling and cutting tools at the sharp end are much smaller, what was once a major operation is now less invasive.

As with Image Guided Intensity Modulated Radiotherapy collateral damage to surrounding healthy tissue is kept to a minimum.

"The DaVinci robot has made a huge difference to prostate surgery" says Prof Neal. "It's still a major operation, but we can be very precise about what we remove and the function we're able to save. That's got to be good news for the patient".