Personalised treatment for prostate cancer patients: are we there yet?

Prostate cancer (PCa) is an extremely heterogeneous disease—a small proportion of patients present with rapidly progressing, aggressive disease, referred to as unfavourable-risk PCa; whilst more commonly the disease progresses far more slowly and does not present an immediate health risk (1). This latter category, known as favourable-risk PCa, is not typically treated through intervention—instead, the recommendation for favourable-risk patients is monitoring via active surveillance (AS) (2). Generally, AS strategies are effective (3), although long-term surveillance studies have demonstrated PCa progression, in the form of disease grade reclassification (GR), in around 25% of cases by 10 years post-diagnosis (4,5). This GR risk is increased further in those of African-American race or advanced age (5,6). This propensity for PCa to progress during AS in some patients but not others, and particularly the association of GR with a particular ethnic group, suggests that underlying genetic factors may be important in disease progression, even in favourable-risk cases. Interrogating this heterogeneity provides a promising route to further stratify patients by their risk of disease progression, to better inform clinical assessment and lead to personalised treatment options.