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Researchers are now able to detect aggressive prostate cancer
Researchers have identified new characteristics of this type of cancer for the first time ever.
Prostate cancer is the most common form of cancer among men in Western countries.
Can aggressive prostate cancer eventually be detected through a few drops of semen or blood? The new research lays the groundwork for that.
Studies have detected cancer of the prostate in half of men over the age of 60, and in about 70 per cent of men over 80 yeard old.
This shows that the disease is naturally linked to ageing.
The cancer develops slowly
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“Prostate cancer often develops very slowly. For the vast majority, this is a disease that you live well with, without the need for treatment, but some get an aggressive variant with recurrence of cancer even after surgery," says May-Britt Tessem, a professor at NTNU.
The disease behaves very differently from patient to patient. Understanding what makes the cancer aggressive is crucial for better diagnostics and treatment, she explains.
Tessem believes that existing methods aren’t good enough for detecting who develops a mild variant versus those who get the aggressive type.
A research team from NTNU, led by Tessem, has become the first in the world to successfully detect aggressive prostate cancer.
In a large study, the researchers analysed prostate tissue using advanced methods that combine genetic data, metabolic analyses, and detailed tissue images.
The aim was to find new characteristics that can predict which patients will develop aggressive disease.
They succeeded.
The results show two important findings
First, aggressive cancer has its own gene expression, Tessem explains.
The researchers identified a pattern in the gene expression of the tumour itself in prostate tissue from patients with a high risk of recurrence and spread.
This signature can become a new tool for distinguishing between patients who need intensive care and those who can manage with less intensive follow-up.
Second, the researchers discovered inflammation in seemingly healthy tissue.
Signs of inflammation and changes in metabolic processes were also found in the normal tissue close to the cancerous tumour.
May provide better methods for early identification
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These glands had high activity of neurotransmitters that attract immune cells, and an increased occurrence of a cell type that can trigger inflammatory reactions.
At the same time, the levels of important substances had decreased. This suggests that the gland had lost its normal function.
“Aggressive prostate cancer appears to be associated with inflammation in the area around the cancer cells, combined with specific genetic signatures and metabolic changes in the prostate tissue. This knowledge can provide better methods for early identification of patients at high risk,” says Tessem.
Cancer returns after surgery in 30 per cent of patients
Prostate cancer progresses slowly, which means that research on this disease can be slow.
It takes an average of nine years from surgery to a recurrence. About 30 per cent have a recurrence of cancer after surgical removal.
"What we have done is to use samples from some patients who experienced recurrence, and whom we can therefore define as having an aggressive disease. Then we compared these with samples from those who did not get cancer again and therefore didn’t have aggressive disease," says Tessem.
The actual samples from the patients were taken about ten to fifteen years ago. She adds that as a researcher, it's important to be persistent.
The samples were taken in Trondheim, and controlled in patient cohorts of more than 2,000 patients.
The number of new cases is about 5,200 each year
Today, prostate cancer is detected through a rectal exam by a doctor and a blood test called PSA.
Since it has become more common for men to take this blood test, the number of new cases of prostate cancer has risen sharply. The number of new cases in Norway is now about 5,200 each year.
When more people are tested for a disease that naturally occurs as part of the ageing process, the next medical step after the blood test must also be carried out more often, so that doctors get a broader clinical picture of the severity.
Today, this involves taking an MRI that provides a detailed image of the prostate gland and surrounding tissues.
Want to lower the threshold for easy screening
Researcher Sebastian Krossa at NTNU has been central to the research. He says it's a well-known problem that many men ignore illness, and that the threshold for a rectal exam is high.
“The PSA test taken with a blood sample today is a correct and important step in lowering this threshold. Nevertheless, it's unfortunately still resource-intensive to determine which patients need intensive follow-up," he says.
"The goal of our research is to lay the foundation for it to be possible to easily screen who has aggressive cancer, for example through blood or sperm samples,” says Krossa.
Tessem emphasises that preventing overtreatment is just as important a goal as uncovering those who really need treatment,
“We know that prostate treatment can greatly reduce the quality of life with significant side effects for many patients, such as incontinence, erectile dysfunction, and depression. Some patients need intensive treatment of the disease, but this is not always necessary. Many people are overtreated and suffer unnecessary discomfort as a result,” she says.
Reference:
Krossa et al. Spatial multi-omics identifies aggressive prostate cancer signatures highlighting pro-inflammatory chemokine activity in the tumor microenvironment, Nature Communications, 2025. DOI: 10.1038/s41467-025-65161-9
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Read the Norwegian version of this article on forskning.no
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