This infographic is from pathologyreport.org. It shows a five step approach to the future of Cancers in general.
The future work of the Erg-Fusion mutation of prostate cancer will build on the work that has already be done. One of the biggest changes that is down the line is changing the way doctors diagnose prostate cancer. The current paradigm is to diagnose cancers based off of the first location of metastasis. While this has work to some extent in the past, the literature suggests that it is better to diagnose and treat cancers based off of the genotype of the cancer cell to better prevent metastasis. The Demichelis et al. group tracked prostate cancers with the Erg mutation and saw that the mutation played a crucial role in tumor metastasis.
The Erg fusion mutation played a role in the activation of oncogenes in the tumor cells. This activation of cancer cells allows the cancer to grow rapidly and metastasizes to a different area. The Erg-Fusion mutation serves as a large subset of prostate cancers but does include very type of prostate cancer or cancer in general. Therefore, the Erg fusion mutation could serve as a model that shows how to specify treatment based off of the mutation present in the cancer cells. Roshan-Moniri et al. summed up the current work that is being done in the labs focusing on pairing treatments to specific mutations. The Roshan-Moniri et al. group pointed out the Wang et al. group since this group is working towards developing peptide inhibitors of the gene fusion responsible to the tumorigenesis of the prostate cancer. Specifically, this group is working on proteins that bind to the DNA coding for ERG so that RNA polymerase can not make a copy of the mutated gene. In addition, the peptides designed by this lab have been associated with the degradation of the mutated proteins from the ERG gene. While working on treatments is incredibly important, there is other important work that is needed to be done. For example society needs a way to ensure that the cancer does not progress to a lethal stage.
One of the major innovations towards diagnosing prostate cancer was the PSA test. While this test has saved plenty of live since it has been developed and became readily available, there still is room to improve. This test has a history of having false positives and false negatives. Once it was noticed that the false positives and negatives occurred a considerable amount, researchers examined ways to enhance the diagnostic tool was. The Porter et al. group determined that the PSA diagnostics correlated with ERG expression rates. As the amount of ERG expression increases, the levels of PSA decrease. This is counterintuitive compared to the previous school of though. While many studies looked at PSA levels and cancer diagnoses, not many tied PSA to the mechanism of the cancer. Further diagnostic tools need to not only be better but be able to diagnose which mutation the prostate cancer is. Since these mutations can impact treatment, longevity, and mortality; it is important to incorporate many forms of diagnostic tools to catch the various kinds of prostate cancer before it become a life-threatening illness.