One in four Australian men will be diagnosed with prostate cancer at some stage in their life, but for a disease that’s so common there’s still so much we don’t know about it. Because there is so much we still don’t know, many Australian men are being over-treated, receiving invasive, sometimes life-altering treatments that may not be necessary.

Groundbreaking research at the Garvan Institute is transforming the way we look at prostate cancer, giving us a better understanding of this devastating disease.

How does prostate cancer affect someone’s life?

Prostate cancer can have a profound physical impact on someone’s life, with frequent urination, pelvic pain, and a reduced sex drive eventually progressing to advanced symptoms like sudden, unexpected weight loss and fatigue. But what sometimes gets overlooked is the psychological impact. As the Garvan Institute’s Professor Vanessa Hayes argues, prostate cancer is a disease that can do just as much damage to the mind as the body.

“Traditionally men don’t want to have to deal with or talk about the side effects of having such a condition and living with it for such a long time. Most men will die with prostate cancer, not from prostate cancer,” says Professor Hayes.

“This means having to live 15, 20, 25 years knowing you have this cancer, while not feeling comfortable to talk about it—I think psychologically it’s a very hard cancer to deal with.”

What makes prostate cancer so tricky to deal with?

Prostate cancer differs from some other cancers in the sense that the factors impacting an individual’s likelihood of getting it are largely out of their hands. Other cancers have “modifiable risk factors” based on your lifestyle choices. For example, the amount of time you spend in the sun could be considered a modifiable risk factor for melanoma, while smoking could be considered a modifiable risk factor for being diagnosed with lung cancer.

The problem is the likelihood of getting prostate cancer is affected by factors like aging, family history, and ethnic background. These are not modifiable risk factors, but genetic factors.

How could genomic research help?

Unfortunately, there’s not a lot we can do about the genetic factors we’re born with. You can’t swallow a pill and change your age, family history, or ethnic background. But what researchers at the Garvan Institute are hoping to understand with genomic research is what exactly is happening on a genetic level that is causing the cancer to emerge in certain people.

“We need to look at the DNA sequence of this tumor and what is actually happening to cause this prostate cell to become cancerous,” says Professor Hayes.

What is it about the Garvan Institute’s research that has been so revolutionary?

Driven by revolutionary advances in genetic technology, the Garvan Institute has been able to examine the entire DNA sequence of a cancer cell. Prior to this, scientists were only able to look at a small portion of the human genome, representing roughly 2% of the bigger picture. But new technology has given the Garvan Institute an opportunity to inspect the instrumental drivers of this unusual cancer, offering hope for a way forward.

“Prostate cancer is a disease of the altered genetic code. Genetics provides a definitive answer; it’s a yes/no, there’s a change on, or a change off. And these we can read, so if we can find that on and off button, then we can provide a much better tool to the clinicians to be able to use,” explains Professor Hayes.

What would be the next step?

If the Garvan Institute can understand the instrumental factors driving the disease on a genomic level, there’s a huge opportunity to tailor treatments according to cases. This would ensure patients who are at highest risk are treated effectively and efficiently, while those at lower risk levels avoid receiving unnecessary and unneeded treatments.

“We want to put prostate cancer into treatable buckets. A do nothing bucket. A do very minimal bucket. A get rid of the prostate bucket. And a tailored treatment bucket,” says Professor Hayes.

“We want to be able to go even further than the buckets and treat the individual. As each person is unique, so is their cancer and ultimately so is their treatment. Genomics will allow us to make prostate cancer treatment unique.”