Recent Progress in Prostate Cancer: Q&A With Johann S. de Bono, MD, PhD

Next to skin cancer, prostate cancer is the most diagnosed cancer among men in the United States. Data from the Surveillance, Epidemiology, and End Results (SEER) Program indicate that over 160,000 men in the United States will be diagnosed with the disease in 2017, with the majority of patients having localized prostate cancer.

Early detection is beneficial in this disease, as late-stage prostate cancer may spread to the bones, resulting in a painful and potentially incurable disease with a five-year relative survival rate under 30 percent. In fact, nearly all deaths from prostate cancer result from late-stage metastatic disease.

This week, experts from around the globe will come together in Orlando, Florida, to discuss recent advances in the field at the American Association for Cancer Research Special Conference on Prostate Cancer: Advances in Basic, Translational, and Clinical Research. The four-day event will include conversations about the clinical development of biomarkers, novel drug targets, alternate mechanisms of resistance, and late-breaking results in prostate cancer research. Both scientists and clinicians will be in attendance, setting the stage for unique collaborations and discussions about the latest advances in the field.

We had the pleasure of speaking to conference cochair Johann S. de Bono, MD, PhD, Division Head of Clinical Studies at the Institute of Cancer Research in Sutton, England, to discuss the highlights of the meeting.

Johann S. de Bono, MD, PhD

What prompted this conference about prostate cancer, and what’s the broad scope of this meeting?

There has been a huge increase in our understanding of prostate cancer, and we’ve made enormous progress in elucidating the genomic underpinnings of the disease. This has resulted in major changes in how we think about prostate cancer, resulting in multiple novel therapeutic strategies for treatment. Taken together, this is a very timely meeting with an exciting schedule ahead.

This conference is deliberately very translational, as represented by the background of our attendees, which also includes clinicians. Our meeting is not just about learning the science, it’s about moving the science as quickly as possible to change patient care.

What areas of prostate cancer research are currently yielding the most exciting progress?

The ability to evaluate the tumor’s genomics and to deliver better, kinder, and smarter treatments to patients is certainly one way ahead that we’re all excited about. Drugs that target the DNA repair pathways, such as PARP inhibitors, are a particularly exciting area for us in the field. There are also opportunities for taking immunotherapy to a subset of prostate cancers, and this conference will help in taking these ideas into clinical reality.

Our understanding of the disease biology is burgeoning, and this is resulting in a lot of exciting data coming through that allows us to understand how prostate cancer evolves. Hopefully we can utilize this information to prevent prostate cancer, especially in a high-risk population.

What are some of the big unknowns in the development of this disease, and what are the top research priorities in prostate cancer?

Prostate cancer is highly heterogenous. We informally refer to the disease as “prostate cancer” when in fact we are truly talking about “prostate cancers,” as there are many different types of prostate cancer. Understanding what types of prostate cancers are benign and do not require treatment is key for individual patients with the disease. Additionally, from a health economic perspective, it would be ideal if we could decrease the overtreatment of benign disease and focus on improving the treatment of aggressive prostate cancers. There’s a session during the conference titled “Prostate Cancer Behavior – Distinguishing the Tigers from the Kittens” that highlights this topic.

Our goal, through upcoming genomics studies, is to better understand the “Achilles’ heels” in this disease that can be targeted to improve treatment. Another priority is to eventually treat patients without impacting their hormone status, as hormone deprivation is currently a key part of prostate cancer care. We want to have kinder and better therapies for patients. Once men are diagnosed with aggressive disease, we chemically deprive them of hormones, resulting in “chemical castration” and a loss of sexual function and other factors. If we could develop better therapeutic strategies based on our understanding of the genomics of prostate cancer, we may not have to rely on hormone therapy.

From my perspective, we also need to focus on survivorship. As people live longer, we need to find ways to deliver better and gentler therapies. Two sessions from the conference – “Translating Prostate Cancer Genomics” and “Novel Therapeutic Strategies and Drug Targets” – will feature these topics.

What session are you most looking forward to attending, and why?

We’ve got a very strong meeting this year. I’m definitely looking forward to the session “Hot Topics in Prostate Cancer Research: Late-Breaking Results.” It’s always exciting to see the brightest young researchers present their results about the latest data in the field.

What do you believe are the biggest challenges in advancing prostate cancer research?

Funding is a key limitation. We also need to train the next generation of scientists, and these meetings are integral in ensuring that young scientists are being exposed to what’s going on in the field. We also need to focus on designing and running smart clinical trials to impact patient care.

We have made big progress in understanding the disease in recent years, but there’s a still lot left to be done. Onwards and upwards!

Editor’s note: On Dec. 5, Norman “Ned” Sharpless, MD, the new director of the National Cancer Institute (NCI), will deliver the closing keynote address at the conference. His talk is entitled “Impressions of a New NCI Director.” For more on the conference, here’s an interview with cochair Karen Knudsen, PhD, director of the Sidney Kimmel Cancer Center at Jefferson.