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Mason. J Cancer Metastasis Treat 2017;3:271-7 Journal of
DOI: 10.20517/2394-4722.2017.51
Cancer Metastasis and Treatment

www.jcmtjournal.com
Topic: How does the prostate cancer microenvironment affect Open Access
the metastatic process and/or treatment outcome?

Getting better at treating prostate cancer:

what clinicians should want from scientists

Malcolm Mason
School of Medicine, Cardiff University, Cardiff CF10 3XQ, Wales, UK.

Correspondence to: Dr. Malcolm Mason, School of Medicine, Cardiff University, Cardiff CF10 3XQ, Wales, UK. E-mail: MasonMD@cardiff.ac.uk
How to cite this article: Mason M. Getting better at treating prostate cancer: what clinicians should want from scientists. J Cancer Metastasis
Treat 2017;3:271-7.
ABSTRACT
Article history: If the treatment landscape for prostate cancer is to be transformed, clinicians and scientists
Received: 18 Aug 2017 must work together ever more closely. Prostate cancer defeats physicians when patients are
First decision: 18 Sep 2017 not accurately stratified according to patients’ risk of dying of disease, when the effects of
Revised: 26 Sep 2017 tumor heterogeneity are insufficiently understood, and when attempts at therapy by clinicians
Accepted: 26 Oct 2017 spur further disease evolution and the emergence of new resistance mechanisms. At the
Published: 17 Nov 2017 same time, clinicians’ over-treat men who in reality do not need it, and some of those men
needlessly suffer long term side effects as a result. This commentary is aimed at stimulating
Key words: debate about how we as clinicians and scientists can assist one another and improve our
Prostate cancer, knowledge to the benefit of patients dying from metastatic disease.
metastasis,
androgen deprivation therapy,
abiraterone STAMPEDE trial,
LATTITUDE trial

WHAT DO CLINICIANS WANT TO KNOW? In a brief survey of clinicians in the UK National Cancer
Research Institute’s prostate cancer Clinical Studies
Group (Mason, unpublished), the distinction between
“Is cure possible? Is cure necessary? Is cure possible the two was the most frequent item on the “wish list”
only when it is not necessary?” This - now almost that these clinicians cited. Conversely, for patients with
legendary - quote by the late American Urologist metastatic prostate cancer, the most common cause of
Willett Whitmore neatly sums up the entire clinical death - by some margin - is due to prostate cancer .
[2]
[1]
dilemma that is prostate cancer . The concept of For patients with “significant” disease, and particularly
“overdiagnosis” and “over treatment” as it relates to those with metastatic disease, cure is currently
early prostate cancer is now widely accepted. One virtually impossible, and there is an urgent imperative
commonly used and useful, though scientifically to improve treatment. The oft-repeated platitude that
imprecise, analogy, when talking to patients is that a man is “more likely to die with his prostate cancer
prostate cancers can either be “tigers” or “pussy cats”. than of it” is completely inappropriate for someone
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