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Personalized Healthcare: A New Approach to Prostate Cancer Screening

Examining the shift towards tailored prostate cancer screening based on genetic and family factors.

Jason L Vassy, Anna M Dornisch, Roshan Karunamuni, Michael Gatzen, Christopher J Kachulis, Niall J Lennon, Charles A Brunette, Morgan E Danowski, Richard L Hauger, Isla P Garraway, Adam S Kibel, Kyung Min Lee, Julie A Lynch, Kara N Maxwell, Brent S Rose, Craig C Teerlink, George J Xu, Sean E Hofherr, Katherine A Lafferty, Katie Larkin, Edyta Malolepsza, Candace J Patterson, Diana M Toledo, Jenny L Donovan, Freddie Hamdy, Richard M Martin, David E Neal, Emma L Turner, Ole A Andreassen, Anders M Dale, Ian G Mills, Jyotsna Batra, Judith Clements, Olivier Cussenot, Cezary Cybulski, Rosalind A Eeles, Jay H Fowke, Eli Marie Grindedal, Robert J Hamilton, Jasmine Lim, Yong-Jie Lu, Robert J MacInnis, Christiane Maier, Lorelei A Mucci, Luc Multigner, Susan L Neuhausen, Sune F Nielsen, Marie-Élise Parent, Jong Y Park, Gyorgy Petrovics, Anna Plym, Azad Razack, Barry S Rosenstein, Johanna Schleutker, Karina Dalsgaard Sørensen, Ruth C Travis, Ana Vega, Catharine M L West, Fredrik Wiklund, Wei Zheng, Tyler M Seibert

― 6 min read


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Table of Contents

Healthcare is changing fast. Instead of treating everyone the same way, doctors are starting to consider individual needs, risks, and even your family background. Think of it like tailoring a suit. Just as a tailor measures you for the perfect fit, doctors are creating customized healthcare plans based on risk. This personalized approach is particularly important for preventing diseases and catching them early.

The Role of Genetics

One big player in this change is genetics. Our genes can tell us a lot about our chances of developing certain diseases. By looking at genetic data, doctors can create better predictions about who might get sick and when. However, while the potential is huge, we still need more studies to prove that using these genetic insights leads to better health outcomes for patients.

Learning from Genomic Biobanks

Healthcare systems that have access to large stores of genetic information, known as genomic biobanks, hold a lot of promise. These systems can collect data and learn if genetic testing helps in predicting disease. It could improve how we manage screening and preventive care. The ultimate goal is simple: better health for everyone, and sharing what we learn with other healthcare systems.

The Case of Prostate Cancer Screening

One area where personalized healthcare can make a real impact is in prostate cancer screening. Prostate cancer is quite common and can run in families. Researchers have found links between genetic factors and this disease, which means it’s possible to identify who is at higher risk. But, there’s still debate about how to screen different groups of people effectively.

Over-screening can lead to unnecessary treatments and anxiety for some men, while under-screening might miss cases that need attention. There’s no one-size-fits-all solution, and that’s where personalized healthcare shines.

Developing a Prostate Cancer Risk Model

To address this, researchers came up with a new risk model for prostate cancer screening called the Prostate CAncer integrated Risk Evaluation (P-CARE) model. This model takes into account genetic scores and family history to better predict who may benefit from screening. They used a large database of health records and genetic data to create and test this model.

Study Overview and Methodology

The researchers started with a big dataset from a veterans’ health program. They updated earlier models using new polygenic scores, which assess multiple genes that contribute to prostate cancer risk. The P-CARE model was then tested against other datasets to ensure it worked across different groups of men.

They did a lot of number crunching, examining how well the model predicted different outcomes based on genetic traits and family history. It looked promising, showing clear patterns in risk that could guide screening decisions.

Data Analysis and Findings

Data analysis involved looking at a massive number of participants and different factors that could influence prostate cancer risk. The model proved to be reliable, identifying high-risk individuals effectively. For instance, the researchers found that men with a family history of prostate cancer were more likely to need screening sooner.

The researchers also considered genetic factors that could affect how men respond to prostate cancer treatments. Having this information allows doctors to make informed decisions and avoid unnecessary tests or treatments for those who are not at high risk.

Creating a Clinical Laboratory Test

Next, the team needed a way to put this model into practice. They developed a blended genome-exome test that combines two types of genetic sequencing. This test provides detailed information about both common and rare genetic variations linked to prostate cancer.

Testing and Validating the Laboratory Assay

With the test ready, the researchers needed to validate it. They compared the genetic findings from this new test with those from standard genome sequencing to ensure accuracy. Most of the genes passed the tests, confirming that the new assay worked well for identifying risks.

Clinical Application and Reporting

After passing all validation steps, the team created a reporting system for doctors and patients. This report summarizes the patient’s risks based on the P-CARE model and highlights any significant genetic findings. Doctors can use this information to tailor screening recommendations effectively.

Clinical Trial Implementation

The real excitement comes with the launch of a clinical trial called ProGRESS. This study will test the effectiveness of the P-CARE model in a larger group of men. By comparing standard care to the new precision screening approach, researchers hope to prove that personalized healthcare can lead to better outcomes.

Implications for Prostate Cancer Screening

This effort to personalize healthcare may help address disparities in prostate cancer outcomes, especially among groups that are at higher risk. By using genetics rather than race as a factor, the model aims to avoid the pitfalls of past models that made broad assumptions based on race alone.

Conclusion: A New Era in Prostate Cancer Care

In summary, this personalized approach to healthcare, especially for something as serious as prostate cancer, is like using a GPS instead of a road map. It’s all about knowing the best route for each person based on their unique genetics and family history. Ultimately, this could lead to increased efficiency in screening practices, better outcomes for patients, and overall improved public health.

Future Directions

As this model matures, researchers will also look to include other risk factors, such as lifestyle and environmental influences. The goal is to create an even more comprehensive tool that helps everyone access the best possible care.

The Importance of Continuous Learning

The ongoing collection and analysis of health data will be essential in refining these models. As we learn more, the healthcare system can adapt and improve, ensuring that everyone gets the preventive care they need-without any unnecessary stress from over-screening.

Closing Thoughts

The move towards personalized healthcare may seem complex, but at its core, it’s about making sure that everyone receives the right care at the right time. As health systems continue to evolve, we can look forward to a future where medical care feels a little less like guesswork and a bit more like a well-fitted suit.

This could ultimately change the landscape of preventive healthcare, turning potential health risks into manageable ones and saving lives in the process.

Original Source

Title: From a genomic risk model to clinical trial implementation in a learning health system: the ProGRESS Study

Abstract: BackgroundAs healthcare moves from a one-size-fits-all approach towards precision care, individual risk prediction is an important step in disease prevention and early detection. Biobank-linked healthcare systems can generate knowledge about genomic risk and test the impact of implementing that knowledge in care. Risk-stratified prostate cancer screening is one clinical application that might benefit from such an approach. MethodsWe developed a clinical translation pipeline for genomics-informed prostate cancer screening in a national healthcare system. We used data from 585,418 male participants of the Veterans Affairs (VA) Million Veteran Program (MVP), among whom 101,920 self-identify as Black/African-American, to develop and validate the Prostate CAncer integrated Risk Evaluation (P-CARE) model, a prostate cancer risk prediction model based on a polygenic score, family history, and genetic principal components. The model was externally validated in data from 18,457 PRACTICAL Consortium participants. A novel blended genome-exome (BGE) platform was used to develop a clinical laboratory assay for both the P-CARE model and rare variants in prostate cancer-associated genes, including additional validation in 74,331 samples from the All of Us Research Program. ResultsIn overall and ancestry-stratified analyses, the polygenic score of 601 variants was associated with any, metastatic, and fatal prostate cancer in MVP and PRACTICAL. Values of the P-CARE model at [≥]80th percentile in the multiancestry cohort overall were associated with hazard ratios (HR) of 2.75 (95% CI 2.66-2.84), 2.78 (95% CI 2.54-2.99), and 2.59 (95% CI 2.22-2.97) for any, metastatic, and fatal prostate cancer in MVP, respectively, compared to the median. When high- and low-risk groups were defined as P-CARE HR>1.5 and HR

Authors: Jason L Vassy, Anna M Dornisch, Roshan Karunamuni, Michael Gatzen, Christopher J Kachulis, Niall J Lennon, Charles A Brunette, Morgan E Danowski, Richard L Hauger, Isla P Garraway, Adam S Kibel, Kyung Min Lee, Julie A Lynch, Kara N Maxwell, Brent S Rose, Craig C Teerlink, George J Xu, Sean E Hofherr, Katherine A Lafferty, Katie Larkin, Edyta Malolepsza, Candace J Patterson, Diana M Toledo, Jenny L Donovan, Freddie Hamdy, Richard M Martin, David E Neal, Emma L Turner, Ole A Andreassen, Anders M Dale, Ian G Mills, Jyotsna Batra, Judith Clements, Olivier Cussenot, Cezary Cybulski, Rosalind A Eeles, Jay H Fowke, Eli Marie Grindedal, Robert J Hamilton, Jasmine Lim, Yong-Jie Lu, Robert J MacInnis, Christiane Maier, Lorelei A Mucci, Luc Multigner, Susan L Neuhausen, Sune F Nielsen, Marie-Élise Parent, Jong Y Park, Gyorgy Petrovics, Anna Plym, Azad Razack, Barry S Rosenstein, Johanna Schleutker, Karina Dalsgaard Sørensen, Ruth C Travis, Ana Vega, Catharine M L West, Fredrik Wiklund, Wei Zheng, Tyler M Seibert

Last Update: 2024-11-04 00:00:00

Language: English

Source URL: https://www.medrxiv.org/content/10.1101/2024.11.03.24316516

Source PDF: https://www.medrxiv.org/content/10.1101/2024.11.03.24316516.full.pdf

Licence: https://creativecommons.org/publicdomain/zero/1.0/

Changes: This summary was created with assistance from AI and may have inaccuracies. For accurate information, please refer to the original source documents linked here.

Thank you to medrxiv for use of its open access interoperability.

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