Prostate cancer management: long-term beliefs, epidemic developments in the early twenty-first century and 3PM dimensional solutions

Radek Kucera; Ladislav Pecen; Ondrej Topolcan; Anshu Raj Dahal; Vincenzo Costigliola; Frank A Giordano; Olga Golubnitschaja

doi:10.1007/s13167-020-00214-1

Prostate cancer management: long-term beliefs, epidemic developments in the early twenty-first century and 3PM dimensional solutions

EPMA J. 2020 Jun 26;11(3):399-418. doi: 10.1007/s13167-020-00214-1. eCollection 2020 Sep.

Authors

Radek Kucera^#¹, Ladislav Pecen^#¹, Ondrej Topolcan¹, Anshu Raj Dahal², Vincenzo Costigliola³, Frank A Giordano⁴, Olga Golubnitschaja⁵

Affiliations

¹ Department of Immunochemistry Diagnostics, University Hospital and Faculty of Medicine, Pilsen, Czech Republic.
² Center of Molecular Biotechnology, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
³ European Medical Association, Brussels, Belgium.
⁴ Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
⁵ Predictive, Preventive and Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.

^# Contributed equally.

Abstract

In the early twenty-first century, societies around the world are facing the paradoxal epidemic development of PCa as a non-communicable disease. PCa is the most frequently diagnosed cancer for men in several countries such as the USA. Permanently improving diagnostics and treatments in the PCa management causes an impressive divergence between, on one hand, permanently increasing numbers of diagnosed PCa cases and, on the other hand, stable or even slightly decreasing mortality rates. Still, aspects listed below are waiting for innovate solutions in the context of predictive approaches, targeted prevention and personalisation of medical care (PPPM / 3PM).A.PCa belongs to the cancer types with the highest incidence worldwide. Corresponding economic burden is enormous. Moreover, the costs of treating PCa are currently increasing more quickly than those of any other cancer. Implementing individualised patient profiles and adapted treatment algorithms would make currently too heterogeneous landscape of PCa treatment costs more transparent providing clear "road map" for the cost saving.B.PCa is a systemic multi-factorial disease. Consequently, predictive diagnostics by liquid biopsy analysis is instrumental for the disease prediction, targeted prevention and curative treatments at early stages.C.The incidence of metastasising PCa is rapidly increasing particularly in younger populations. Exemplified by trends observed in the USA, prognosis is that the annual burden will increase by over 40% in 2025. To this end, one of the evident deficits is the reactive character of medical services currently provided to populations. Innovative screening programmes might be useful to identify persons in suboptimal health conditions before the clinical onset of metastasising PCa. Strong predisposition to systemic hypoxic conditions and ischemic lesions (e.g. characteristic for individuals with Flammer syndrome phenotype) and low-grade inflammation might be indicative for specific phenotyping and genotyping in metastasising PCa screening and disease management. Predictive liquid biopsy tests for CTC enumeration and their molecular characterisation are considered to be useful for secondary prevention of metastatic disease in PCa patients.D.Particular rapidly increasing PCa incidence rates are characteristic for adolescents and young adults aged 15-40 years. Patients with early onset prostate cancer pose unique challenges; multi-factorial risks for these trends are proposed. Consequently, multi-level diagnostics including phenotyping and multi-omics are considered to be the most appropriate tool for the risk assessment, prediction and prognosis. Accumulating evidence suggests that early onset prostate cancer is a distinct phenotype from both aetiological and clinical perspectives deserving particular attention from view point of 3P medical approaches.

Keywords: 3PM); Adapted treatment algorithms; Adolescence; Aetiology; Age; Aggressive metastatic disease; Alcohol consumption; Androgen dependent; Apoptosis resistance; Biomarker patterns; Body mass index BMI; Bone-specific alkaline phosphatase; C-index; Castration resistant; Choline; Circulating tumour cells (CTC); Coffee; Comorbidities; Curcumin; Diet; Disease manifestation; Economy; Elderly; Ellargic acid; Ethics; Ethnicity; Family history; Fish; Folate; Fruits; Garlic; Genetic; Green tea; Gut microbiota; Human development index; Hybrid imaging; Incidence; Indicator; Individualised patient profile; Inflammation; Insulin-like growth factor; Ischemic lesions; Lactate dehydrogenase; Life quality; Lifestyle; Liquid biopsy; Lycopene; Malignancy; Meat; Microcirculation; Modifiable risk factors; Mortality; Multi-factorial systemic disease; Multi-omics; Multi-parametric analysis; Obesity; Oxidative stress; PET/MRI; PSA screening; Patient stratification; Personalised nutrition; Physical activity; Prebiotics; Predictive preventive personalised medicine (PPPM; Probiotics; Prognosis; Prostate cancer (PCa); Prostate cancer antigen 3; Quercetin; Race; Radical prostatectomy; Risk assessment; Roadmap; Saturated fat; Selenium/selenite; Sexually transmitted diseases; Sleep disorders; Smoking; Socio-economic factors; Stillbenes; Sulphorapane; Survival; Systemic hypoxic condition; Toxic environment; Trace elements; Transrectal ultrasound; Trends; Urinary tract infection; Urology; Vasectomy; Vegetables; Vitamins A, C, D, E, and K; Young population; miRNA.

Publication types

Review