How risky is your prostate cancer?

Prostate cancer treatment has become controversial -- not because the disease is usually deadly, but because it so often isn't. Many men have microscopic, slow-growing malignancies in the prostate gland that would not cause health problems and would never have been diagnosed if not for the sensitive blood test now standard. Yet because clinicians have had limited ability to determine which cases of prostate cancer are genuinely life threatening, patients may unnecessarily receive aggressive treatment that can cause incontinence or impotence.

New research by John Concato, professor of medicine, and his colleagues may point the way toward a solution. Concato's team examined initial biopsy tissue from 1,007 men diagnosed with prostate cancer between 1991 and 1995, and then tracked these patients' health status through 2006.

In the May 5 Annals of Internal Medicine, they identified three biomarkers correlated with greater mortality -- two gene variants and high microvessel density. "Based on our findings, more than a third of men would be at higher risk according to the status of their markers," Concato said.

An accompanying editorial criticized the study for the relatively small number of biomarkers it tested and limited likely effect on clinical practice. Concato acknowledged that the work might not change initial treatment patterns, but said the markers could help distinguish patients who would likely need more-intensive treatment later, and that new, targeted therapies might be developed based on the markers.

And biomarker testing may also help inform patients and their families, he said. "If a relative of mine was diagnosed with prostate cancer, I would want to know their marker status."