(UroToday.com) The 2024 SUO annual meeting included a prostate cancer session, featuring a presentation by Dr. Ganesh Palapattu discussing the biology of cancer metastases. Dr. Palapattu started his presentation by emphasizing that the reason we should care about the biology of cancer metastasis is that we may be able to improve risk stratification of localized disease and that we also may be able to improve therapy for advanced disease.
From a historical perspective, in 1829, Récamier stated that “metastasis” is from the Greek word “methistemi” – displacement, or to change/remove. In 1889, Paget introduced the “seed and soil” theory, and in 1928, Ewing suggested that metastases may occur secondary to lymphatic and vascular channels. This has led to several prevailing theories:
- Halstead (1894): step wise spread theory
- Keynes (1956)/Fisher (1980); systemic spread theory
- Hellman (1994): spectrum theory
The self seeding theory is summarized by the following two figures:
The following also highlights the theory of dissemination, dormancy, and colonization of metastatic cancer cells:1
Dr. Palapattu notes that within micrometastatic disease, these cells have to survive, but also thrive and then exit dormancy, which is the point when cancer may be lethal:2
Dr. Palapattu notes that there is likely a clonal origin of metastases:3
But that both monoclonal and polyclonal origins are likely to coincide:4
Dr. Palapattu concluded his presentation discussing the biology of cancer metastases with the following take home messages:
- There are several lessons to be learned:
- Biology is paramount
- Heterogeneity is rampant
- Hubris is dangerous
- Breast cancer is decades ahead of prostate cancer with regards to understanding primary treatment and collaborative risk assessment and evalution of patients
Presented by: Ganesh Palapattu, MD, FACS, University of Michigan, Ann Arbor, MI
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 Society of Urologic Oncology (SUO) Annual Meeting, Dallas, TX, Tues, Dec 3 – Fri, Dec 6, 2024.
References:
- Gerstberger S, Jiang Q, Ganesh K. Metastasis. Cell. 2023 Apr 13;186(8):1564-1579.
- Ganesh K, Massague J. Targeting metastatic cancer. Nat Med. 2021 Jan;27(1):34-44.
- Ulintz PJ, Greenson JK, Wu R, et al. Lymph node metastases in colon cancer are polyclonal. Clin Cancer Res. 2018 May 1;24(9):2214-2224.
- Birkbak NJ, McGranahan N. Cancer Genome Evolutionary Trajectories in Metastasis. Cancer Cell. 2020 Jan 13;37(1):8-19.