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Frontiers in Mathematical Oncology

Challenges in Prostate Cancer: Are there mathematical solutions?

Peter Choyke

National Institutes of Health


Prostate Cancer is a major health care issue affecting approximately 1 in 6 males typically after age 50.  Prostate cancer is unusual in that it has a broad range of aggressiveness, from indolent to highly malignant.  There is a controversy whether the most well differentiated form of prostate cancer is even a cancer in the standard sense of the word.  Early detection is a desirable goal.  One major problem, however, is designing a program that identifies men who are at high risk for aggressive prostate but not indolent disease.  The current method of screening using PSA testing has been discredited by advisory agencies but the basis for these declarations has been criticized. One major criticism of screening is that it leads to overtreatment.  However, the introduction of MRI and active surveillance allows patients with low risk cancers to be monitored instead of treated.  Another major challenge is to differentiate cancers that must be treated from those that may simply be observed.   Once a patient is actually treated with surgery or radiation,  the same challenge occurs as tumors in patients who recur after treatment have variable aggressiveness.  Who amongst these patients needs immediate treatment?  All of these issues must be balanced with the life expectancy of the patient given the long duration of the disease (10+ years in many cases).  Finally, when a tumor becomes metastatic the biologic diversity remains evident with markedly different survival curves depending on treatment strategies and tumor biology.   Conversion from an androgen receptor-dependent growth to the so called “neuroendocrine” type of cancer also becomes important in determining treatment and outcomes.  These complex issues are data rich problems that would greatly benefit from a mathematical modeling approach so that, in an individual patient, we can better understand the risks and benefits of specific management strategies.