EMUC15: Unlocking new prostate cancer treatment strategies through next-generation pathology

Leading pathologist Prof. Carlos Cordon-Cardo, chairman of the Department of Pathology and Genetics at the Icahn School ofMedicine at Mount Sinai, delivered a state-of-the-art lecture titled “Next Generation Pathology: Predicting clinical course and targeting disease causation,” wherein he outlined new prospects in investigating prostate cancer at the cellular level.

“One of the main points in diagnosis is the development of algorithms that bring quantification and the weight of specific markers rather than the subjective opinions of different pathologists or individuals,” said Cardo. “This may give us a better opportunity to have a multidimensional view of the patient and better predictive and prognostic algorithms. It's clear that when you put all of that together, the sensitivity, specificity and hazards ratio go up enormously.”

Cordon-Cardo believes this new approach will be a part of the future of diagnosis, which he described as “integrating data to percolate knowledge”.

He also noted that there is “more than what the eye sees”. Cordon Cardo: “While we have been making major strides in better understanding cancer and other diseases, the reality is we keep treating most of the chronic diseases based on their symptomatology. When an individual has hypertension we give, sometimes, diuretics… There is probably a place somewhere that is a regulator of blood pressure, but we don’t know it.”

According to Cordon-Cardo, it’s the same case with cancer investigations, noting that medical researchers would be better served if they adjust and shift their focus.

“We are treating most of the cancer patients with drugs that affect cell division because it’s a characteristic of cancer, it’s the symptomatology of cancer. But normal cells also divide. So we have identified a sub-population of cells that is different from the cells we have seen, it’s a cell that is very differentiated and doesn’t follow the regular rules that we are used to,” he explained.

He underscored the need to learn more about this so-called “maverick” cell. “It’s the only cell that has the capability of initiating tumours and metastasis. If that is the case, then we have to learn how to target this cell, which may have different targets than the differentiator cells. And by putting it together we may, first of all, better understand cancer and offer better treatment.”

Cordon-Cardo and his team have identified the cells in the last couple of years and are doing various analysis to better understand what these cells are susceptible to.

“We are identifying targets that are now in phase 1-2 clinical trials. I think it’s very encouraging. We have also seen these cells in bladder and colon cancers. Chances are that there is a much more universal, basic mechanism that could help us better understand cancer in general, not only prostate cancer,” he said.