Identifying & Treating Neuroendocrine (Advanced) Prostate Cancer

Prostate Cancer

Around 47,000 men are diagnosed with Prostate Cancer each year in the UK and approximately 11,000 will die from the disease every year.
The prostate is a small walnut shaped gland which sits under the bladder. Its main function is to produce semen.
Prostate cancer is usually detected using a PSA screening test and confirmed by a biopsy.
Small tumours (TI-II) can be monitored without intervention. This avoids unnecessary treatment and the associated side effects.
Larger tumours will require treatment which may include brachytherapy, radiotherapy, chemotherapy, surgery or hormone therapy.
Prostate Cancer depends on testosterone to grow. Hormone therapy blocks or lowers the amount of testosterone in the body. This can lower the risk of an early Prostate Cancer coming back when you have it with other treatments. Or it can shrink an advanced Prostate Cancer or slow its growth.

Advanced Prostate Cancer

Advanced (metastatic) prostate cancer is cancer that has spread from the prostate to other parts of the body, most commonly to the bones and lymph nodes. It’s not currently possible to cure advanced prostate cancer.

Survival rates for men with advanced prostate cancer are poor; the shocking statistic is only 30% of men survive 5 years. These men are in desperate need of our help. Our cancer research team is focusing on developing new and better targeted treatments to help keep advanced prostate cancer under control, manage symptoms, and ultimately extend the lives of men with advanced prostate cancer.

We have been able to carry out this work due partly to the generosity of Univar, who has supported us for many years. They recently funded a PhD studentship which has been completed by Chris Smith.

Chris’ research investigated an aggressive life-threatening form of advanced prostate cancer – NEPC (Neuroendocrine Prostate Cancer), which is underdiagnosed and has very poor clinical outcomes with very few treatment options. . No other group is investigating this in the UK.

Most Prostate Cancers are a type called adenocarcinoma and are regulated by the male hormone androgen.
Advanced adenocarcinoma of the prostate is typically treated with drugs that cut off the supply of that hormone. Increasingly, however, these cancers are becoming resistant to androgen-blocking treatment and progressing to a more aggressive form of the disease, called Neuroendocrine Prostate Cancer (NEPC).
Neuroendocrine Prostate Cancer does not secrete Prostate Specific Antigen (PSA).
It can therefore be hard to identify when Prostate Cancer has progressed to NEPC as PSA levels do not rise. Because they are aggressive and can’t be picked up by PSA tests, most neuroendocrine prostate cancers are diagnosed when they have already spread to other parts of the body, most commonly the bones. They can only be diagnosed by biopsy or transurethral resection of the prostate (TURP).

Watch our PhD student Chris Smith explain his research into how to accurately identify and treat NEPC, an advanced form of Prostate Cancer. NEPC is frequently under diagnosed resulting in the wrong treatment being given to these men.

Identifying and treating NEPC

New approaches to identify and treat NEPC are urgently needed.
The Targeted Therapy Group at The University of Surrey are investigating ways to identify and alert clinicians to when a patient’s prostate cancer has progressed to NEPC.
The group is developing a simple blood test which will allow NEPC cells circulating in the blood stream to be detected.
New approaches using immunotherapy to prime the patient’s immune system to target the NEPC cells are also being developed. Immunotherapy will ensure that any metastatic NEPC deposits will also be recognised and destroyed by the immune system.
This is vital research work requiring long-term financial support. Please help us if you can.

Chris’s work has led to several exciting discoveries.

Firstly, unique proteins secreted by the cancers cells as they transform from conventional prostate cancer to NEPC are detectable in cancer cells and cancer tissue.

Secondly, Chris has found that the development of NEPC causes profound changes in the prostate cancer tissue, and creates an environment where immune based treatments may be effective. These treatments, are readily available as they are used to treat other cancers, do not normally work in conventional prostate cancer.

HOX genes are a group of genes involved in the development of a fetus; if these genes are later ‘switched on’ again in later life, they been shown to contribute to cancer development and progression in a multitude of cancer types. They have also proved to be useful biomarkers for disease prognosis, progression, and potential diagnosis.
The team is also investigating the HOX gene landscape in NEPC, how they can be used to non-invasively detect and diagnose the disease and how we can target them to treat men with NEPC.

Dr Tyler Wooldridge is now continuing this research in the labs. He is in the pre-clinical testing phase for novel therapies that have been shown to be effective in targeting NEPC and could lead to a new treatment.

Work is also underway to examine and characterise the immune landscape changes from early prostate cancer through to NEPC, which will provide us with a better understanding of the biology of this disease and guide further research as to whether patients with NEPC could benefit from immunotherapy-based treatments

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