Personalized Medicine

As our knowledge of the underlying pathogenesis of cancer increases, clinicians will be able to select patients for more targeted therapeutic options. A number of units are developing tumor and serum biobanks with the aim of characterizing the DNA signature as well as the epigenetic phenomena to correlate with clinical outcomes and response to therapy. A group from Maastricht plans to use a tissue bank to study the genomics and proteomics of patients with penile cancer (National Institute of Health, Identifier NCT00157352). There is a need for consensus between tissue banks on methods of DNA and protein extraction as well as standardization of assay protocols and clinical parameters, so that meaningful comparisons can be made and facilitate collaboration. We look forward to the publication of DNA heat maps, demonstrating the genes that are up-regulated and down regulated in penile cancer. It would be particularly interesting to compare the genetic fingerprint of primary tumors with those from lymph node metastases.

With the evolution of DNA finger-printing and the characterization of cellular processes, it is likely that therapies will be tailored according to a patient's tumor profile. The concept of personalized medicine is currently available in breast cancer, with therapies selected according to estrogen, progesterone, and HER2/neu status. However, this will continually evolve with array-based technologies to develop gene signatures.35 The primary tumor in penile cancer can be easily biopsied for characterization of the cancer prior to choosing the therapy. Furthermore, inguinal nodes are more accessible than intraabdominal lymph nodes in order to perform fine needle aspiration for cytological examination. Therefore, penile cancer is suitable for neoadjuvant targeted therapy of primary and/ or nodal disease. Future urologic oncologists may well work with oncologists who treat other squamous sites (e.g., lung, vulva, or head/neck cancer) in treating cancer based on its DNA and receptor signature rather than the location of the primary tumor.

Fig. 16.1 Age at diagnosis for a total of 100 consecutive patients in the UK2
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