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UTHSCSA
DEAN’S MESSAGE
San Antonio Center of Biomarkers of Risk
for Prostate Cancer (SABOR)
Celebrating 15 Years of Prostate Cancer Research
By Francisco González-Scarano, MD
A 60 year old man has about a 60 percent chance of developing
prostate cancer in his lifetime. On average, 80 percent of men will
develop some form of prostate cancer. It is second only to lung cancer
in mortality rates for men and with the downward trend in smoking,
prostate cancer will probably be No. 1 at some point. However, only
about 2-3 percent of men with prostate cancer die of it.
Prostate cancer takes many forms and further complicating the
equation is the fact that about 75 percent of men with elevated PSA
levels don’t have the disease. And, even though a man may have been
diagnosed with it, in many cases, he will die of old age before he dies
of the cancer. Most men in this category would not even know they
had the disease if they had not been biopsied.
Unfortunately, treatments for prostate cancer (radiation and sur-
gery) are associated with a substantial risk of side effects, including
sexual, urinary, and bowel complications that can dramatically affect
quality of life. Even a biopsy carries with it the risk of incontinence
and impotence.
In general, prostate cancer biopsies fall in to three categories of
need: unnecessary, possibly beneficial, and crucial. The unnecessary
and possibly beneficial ones are wrought with risk. If diagnosed with
a non-progressive, non-lethal form of the disease, the person is la-
beled with a cancer diagnosis, affecting life and health insurance rates men sampled before diagnosis. This base can be used to test new and
as well as triggering potentially harmful tests and procedures.
The challenge becomes how to identify the small percentage of
men who are at a high risk for the aggressive disease form, without
putting all the other men who are at a much lower risk through the
possibly serious side effects of a prostate biopsy and/or treatment.
This identification equation — being able to pinpoint what com-
bination of genetics and other factors put a man into the higher risk
categories — is the goal the San Antonio Center of Biomarkers of
Risk for Prostate Cancer (SABOR) which began here at the School
of Medicine 15 years ago and continues to make significant strides
in how we diagnosis and treat prostate cancer.
One perspective is that the equation is too complex — all men are
at risk and the variables that make up who is and who is not at risk
and should be treated (versus not treating/surveillance), is so complex
as to not be worth solving. The U.S. Preventative Task Force, which
30 San Antonio Medicine • November 2015
is a body authorized and supported by the Agency for Healthcare
Research and Quality (AHRQ), took this position in early 2012, de-
claring that PSA screening of men for prostate cancer is not recom-
mended. Focusing on the cost and harm caused by unnecessary early
detection and treatment of non-progressive cancers, the group has
decided that risk of death/mortality rates of men from prostate cancer
is not sufficiently high to warrant use of the PSA test. The Task Force
does believe that more research is urgently needed to distinguish non-
progressive/ slow-progressive prostate cancer from the ones that are
more aggressive and deadly.
Dr. Ian M. Thompson Jr., director of the Cancer Therapy & Re-
search Center (CTRC) here — who is also a busy prostate cancer sur-
geon as well as a professor of urology in the School of Medicine —
disagrees with the no-PSA recommendation, but very much agrees
with the urgent need for new screening methods and biomarkers. As
the founder of the SABOR program, Dr. Thompson has dedicated a
significant portion of his career to pursuing these and other prostate
cancer elements for prevention, diagnosis and treatment. SABOR,
which was founded in 2001 with a grant from the National Cancer
Institute (NCI), has become a leading center for research and has pro-
duced a number of advancements in prostate cancer screening and de-
tection. As important, it has become a national resource as a statistical
database and biologic sample source with an unprecedented cohort of
novel approaches to other biomarkers for prostate cancers.
The genesis of the SABOR program was the lack of consistency
and scope of most prostate cancer studies which focus on PSA and,
as Dr. Thompson points out, were based on data from white males
who self-selected to go to their doctor and have a blood test done for
PSA. We know race and ethnicity have a great impact on prostate
cancer risk, and as the nation will soon be 30 percent Hispanic, the
SABOR study looks at men from a perspective that will soon be
much more in line with the profile of the American male. Currently
the participants are 38 percent Hispanic, 15 percent African Ameri-
can and the remainder Caucasian. Along with PSA results, the pro-
gram also focuses on the genetics of men with prostate cancer, as well
as environmental and physiological factors such as sun exposure,