Lots more genetic information; practical implications still to come

There is a long (full-text) commentary this week in Nature Genetics about new data just reported by participants in the  large-scale Collaborative Oncological Gene-environment Study (COGS). Some of the data are relevant specifically to risk for prostate cancer. A complementary news report that may be easier for many to digest can be found on the BBC News web site. However, the research is covered on many major news web sites.

This editorial commentary refers to data from some 10 primary articles published this week in Nature Genetics and elsewhere. The papers are all focused on our increasing ability to isolate and identify genetic modifications that can be associated with an apparent increase in risk for cancers of various types (prostate cacner included). However, the degree to which all this genetic information is really going to be useful in the diagnosis of prostate cancer is very questionable unless it can also help us to differentiate with great clarity between clinically significant and clinically insignificant forms of the disease.

It is becoming increasingly clear that no one genetic alteration seems to have the same effect on risk for prostate cancer as it may for other forms of cancer. And we still don’t know to what extent the underlying genetic changes may be impacted by other influences ranging from diet and environment to epigenetic factors.

All this research will be important over time to our greater understanding of why some people get different forms of prostate cancer and others do not. The degree to which it will have any immediate clinical impact on the diagnosis and management of prostate cancer is going to be far smaller — except in the small subset of families that very clearly exhibit hereditary forms of prostate cancer and who therefore are undergoing careful genetic screenings early in life to identify the males who are at elevated hereditary risk.

There is a particularly telling quotation about the current clinical implications of all this research in an article that appears in The Boston Globe. According to Dr. Rosalind Eeles of the Institute of Cancer Research in the United Kingdom, who published one of the papers that included a lot of the data on the genetic risk for prostate cancer:

 What we don’t know is, if your [genetic] risk is over 50 percent of getting prostate cancer in your lifetime, we don’t know if we should just PSA screen you, whether we should do a biopsy, whether we should do an MRI scan.

There’s a way to go before we really understand how convert all this information into practice-changing knowledge.

One Response

  1. Nature Genetics put the entire series of papers, with lots of introductory information, on line last night.

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