Early detection of prostate cancer

SPRINTR – Swedish Prostate cancer initiative for Novel Treatment Regimens – Biomarker driven precision medicine in non-metastatic prostate cancer

National research structure for better diagnosis and studies of prostate cancer

Some people who develop prostate cancer that has a high risk of spreading would probably benefit from receiving chemotherapy earlier than is current practice. Researchers will now develop a diagnostic method that can identify these patients in advance. They will also build a national infrastructure, creating a more efficient way of conducting prostate cancer studies.

Every year, around 2100 men in Sweden die from prostate cancer. In almost half these cases, doctors could not find any metastases at the time of diagnosis, but the cancer still spread later. The question now is whether these people should receive the same treatment as people who are diagnosed with metastatic prostate cancer? Since 2015, they have received chemotherapy in addition to the standard hormone therapy, which increases survival by an average of 14-18 months.

“Around 30% of patients who have no metastases when they are diagnosed would benefit from chemotherapy. The others respond well to hormone therapy alone, and we need to be able to find out who they are,” says Andreas Josefsson, docent and urologist at the University Hospital of Umeå.

Along with a large group of researchers and physicians from across Sweden, he will now receive funding from the Sjöberg Foundation for a flagship project. One of several important goals is finding cost-efficient methods for classifying prostate cancer.

“We will identify biomarkers that can provide the information we need to match patients and treatments,” says Karin Welén, docent at the University of Gothenburg and one of the researchers in the project.

To find the best biomarkers, the researchers will map tissue samples from completed prostate cancer studies. They will study genetic changes, how much of the various proteins are present in the cancer cells, the mRNA expressed by the cancer cells, and develop an AI model to analyse microscopy images of tumour tissue.

Once the researchers have found biomarkers that appear to predict how patients will fare, the next step is to conduct a randomised controlled clinical trial to ensure their conclusions are correct.

As part of this study, they will also introduce a new infrastructure for conducting clinical trials in Sweden. Currently, individual doctors are responsible for inviting patients to studies, but keeping track of which studies are being run in different parts of Sweden is difficult. As a result, patients miss out on studies that could have helped them. It also takes researchers an unnecessarily long time to find all the patients required for a study.

“Instead, we will ask every patient who comes through the urology department’s door and is being investigated for prostate cancer, whether they want to participate in a large basic study of the disease,” says Josefsson.

If patient says yes, researchers will map tissue samples from their tumour. They will then collect data from a range of medical registers, such as the prescribed drug register, various diagnostic registers, and the cause of death register. This will provide researchers with a database  that contains both the tumour’s molecular characterisation and information about patient outcomes.

“All prostate cancer researchers will benefit from this. They will be able to find patients with a certain type of prostate cancer in the database. Then they can send an invitation to the patients and ask if they want to participate in a particular study,” says Welén.

“This will also lead to greater equality in healthcare. People will find out what studies are underway and the threshold for conducting studies will be lower,” says Josefsson.

The final piece of the flagship project’s puzzle is the search for new ways to attack tumours that currently respond poorly to the available treatments.

“We will thoroughly examine the tumours that do not respond to any treatments, and investigate what characterises them,” says Welén.

The researchers hope that mapping them in such detail will bring new ideas for ways of attacking the tumours, so that even more people can be cured or live long lives despite their prostate cancer.

Main applicant:

Andreas Josefsson, docent and specialist physician, Umeå University and the University Hospital of Umeå.

Co-applicants:

Karin Welén, docent, University of Gothenburg

Anders Bergh, Professor, Umeå University

Anders Bjartell, professor and senior consultant, Lund University and Skåne University Hospital

Anna Bill-Axelsson, professor and senior consultant, Uppsala University and Uppsala University Hospital

Camilla Thellenberg, senior lecturer and senior consultant, Umeå University and the University Hospital of Umeå

Carolina Wählby, docent, Uppsala University

Elin Trägårdh, docent and senior consultant, Lund University and Skåne University Hospital

Firas Aljabery, docent and senior consultant, Linköping University and Linköping University Hospital

Joakim Lundeberg, professor, KTH Royal Institute of Technology

Johan Lindberg, senior lecturer, Karolinska Institutet

Johan Stranne, adjunct professor and senior consultant, University of Gothenburg and Sahlgrenska University Hospital

Maréne Landström, professor and senior consultant, Umeå University and the University Hospital of Umeå

Marianne Månsson, docent, University of Gothenburg

Martin Sjöström, senior lecturer and physician, Lund University

Olof Akre, professor and senior consultant, Karolinska Institutet and Karolinska University Hospital

Per Fransson, professor and oncology nurse, Umeå University and the University Hospital of Umeå

Pernilla Sundqvist, docent and urologist, Örebro University and Örebro University Hospital

Pernilla Wikström, professor, Umeå University

Peter Lindgren, professor, Swedish Institute for Health Economics

Päivi Östling, docent, Karolinska Institutet

Sara Strandberg, docent and senior consultant, Umeå University and the University Hospital of Umeå

Tobias Nordström, docent and senior consultant, Karolinska Institutet and Danderyd University Hospital

Tufve Nyholm, professor, Umeå University

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