How many types of prostate cancer are there?


At a meeting of some leading members of the prostate cancer advocacy community yesterday morning, during the ASCO meeting in Orlando, Dr. William Simons of the Prostate Cancer Foundation distributed a diagram suggesting that there may be as many as 15-18 different sub-types of prostate cancer.

It has long been known that not all prostate cancers are the same. At the very simplest level we have been aware that there are indolent and aggressive prostate cancers; there are hormone-responsive and hormone-non-responsive prostate cancers; there are prostate cancers with high and low Gleason scores; etc.

However, what the Prostate Cancer Foundation, working with its broad team of scientific researchers, has now been able to do is look at prostate cancer much more from the point of view of the molecular development of the differing sub-types of this cancer, the molecular targets that can be blocked or stimulated to have particular therapeutic effects, and the specific ways in which the treatments that are known to be effective impact specific molecular targets:

  • The drugs like the LHRH agonists and the antiandrogens impact the androgen receptors.
  • Drugs like abiraterone actetate also impact the androgen receptors, but in a rather different way.
  • Docetaxel affects β-tubulin and can therefore interrupt cancer cell development.

However, there are still at least a dozen other, different pathways that may be particularly important in managing certain subtypes of prostate cancer, and we are only just beginning to appreciate how, when a patients can be shown to have a high level of experssion of certain enzymes or prostein associated with their prostate cancer subtype, we may been to be able to block or or more specific molecular pathways in order to control (or perhaps stop) the developmentof that specific prostate cancer subtype.

The good thing, however, is that we really are making progress in understanding more about the details of how prostate cancer develops and progresses. Such progress is critical to the development of the next generations of products designed to treat and (better still) to prevent prostate cancer, with greater effectiveness and safety than anything we have available today.

6 Responses

  1. How are tests carried out to determine what kind of prostate cancer one has. would the results determine, then, the type of treatment best suited.

  2. Dear Nancy:

    Ther are currently no widely available tests that allow us to differentiate between even the identified subtypes of prostate cancer — unless we are talking about one of the relatively rare subtypes (such as sarcomas of the prostate) that can be identified pathologically.

    Something like 90% of all prostate cancers are what are known as “ademocarcinomas” of the prostate. What we are now only starting to understand is that that there are many different types of adenocarcinoma.

    At the University of Michigan (where a lot of the research into subtypes of adenocarcinoma of the prostate has been carried out), a clinical team can now carry out genetic analysis to see if a particular type of chemotherapy or hormonal therapy might be more appropriate for a specific patient with progressive prostate cancer … but this type of diagnostic testing and prognostic analysis is only at the very earliest stages of clinical application. It may be many years before such tests can become routine.

  3. My father was diagnosis with prostate cancer in January 2008. … It had already spread to his bones by the time they found it. … Now it has spread to the brain and his feet and genitals are swelling. … His doctor says it is due to the cancer and there is nothing else that can be done. … Is there a research center that would be something for me to consider taking him to?

  4. Dear Keri:

    I am sorry to have to tell you that there is no really effective therapy to combat widespread, castration-resistant prostate cancer like this that has spread into the brain and other extremities. Any form of treatment available now will, at best, be able to palliate the symptoms of his cancer.

    Your father is almost certainly an excellent candidate for hospice care, and I think you have done the right thing by contacting the hospice. They should be able to help your father to have minimal pain and suffering and the best possible quality of life under the circumstances.

  5. My father lives on an island in the Pacific and he was told he had prostate [cancer]. They have done surgery and he has been bleeding since; his prostate is swollen and now his urethra is blocked again so can’t go toilet, so they had to put the tube back in him.

    Is that a cancer are they doing the right thing. And is he gonna be OK? Where can I get help?

    Thank you.

  6. Dear Perrine:

    It is not unusual for some patients to need time to recover from prostate cancer surgery and to have problems like those you describe. A lot would depend on the skill and experience of the surgeon who operated on your father. If one lives on some islands in the Pacific, the experience and the skill of the surgeons available may be limited.

    We know far too little about your father, his diagnosis, or even where he lives and was treated to be able to make suggestions about where he (or you) may be able to get help. However, if you join our social network we can talk more about this and we may be able to make some helpful suggestions — but you will need to answer some questions for us first (if you are able to do this).

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