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run their biomarker tests on these samples and then send their results
(predicting risk for prostate cancer) back to SABOR for evaluation
against the database of medical history of the men who provided the
samples. This is all done blind. The SABOR team then compares the
report (which typically gauges risk for prostate cancer) against what
actually happened to the men in the cohort. The SABOR analysis
tells the test group whether or not they hit the mark.
There is a great deal of money to be made in the diagnostic arena,
so the stakes are high and a great number of companies are investing
significantly in the pursuit. Most are disappointed with their SABOR
evaluation and it’s no surprise — as mentioned earlier in the article,
most of their data is from the self-selected men who show up for a
PSA test. This bias was and is the source of most data outside of the
SABOR program.
The validation function is crucial for both sides of the diagnostic
coin. If a new test is showing promise, it helps to establish efficacy. If partners for other cancer calculators that can further enhance the de-
the test/biomarker parameters do not fare well, it helps to prevent their
progress and the subsequent negative consequences. This includes pos-
sible false negatives as well as unnecessary biopsies and other procedures
with the aforementioned risk. In this complex equation with prostate
cancer, it is important to turn off research with tests that don’t work.
Even though the research is coming from some of the most prestigious
institutions in the world, most other cohorts do not contain samples
from men before they were diagnosed with prostate cancer. Following
the men in the study and identifying who developed cancer and who
did not — and being able to look at a wide range of biomarkers —
has proven an invaluable asset in the prostate cancer world. The
SABOR team is also always watching the literature for other tests com-
ing up so they can evaluate them against their database.
The EDRN function is overseen by SABOR geneticist Robin
Leach, PhD, who has been with the SABOR program since day one.
She is a molecular geneticist who in addition to her appointment in
the Department of Cellular and Structural Biology, is appointed in
the Department of Urology where she is the chief of the Division of
Research. She is the co-leader of the Genomics Research Core for the
CTRC and also chairs the biobanking and education committees.
Her lab focuses on identifying and evaluating biomarkers for prostate
cancer. In addition, she is working to identify factors that contribute
to significantly higher incidences of dying from the disease.
Brandi Weaver, SABOR Regulatory Coordinator, has also been
with the program since its inception and runs the urologic tissue
bank. She has been a co-author on the research and Drs. Thompson
and Leach credit her attention to detail and hard work with helping
to make the program the distinguished center it has become in the
32 San Antonio Medicine • November 2015
world of prostate cancer research. As the main contact for SABOR,
Weaver oversees patient recruitment as well as all aspects of the data
collection, including all health informatics and much more.
As Dr. Leach likes to say, with all the data they have on their cohort
— age, weight, genetics, lifestyle and environmental factors and
more, they know more about these men than their mothers. It was
Dr. Leach’s work that helped demonstrate the importance of % free
PSA in the risk calculator. Many other biomarkers, including some
that were very promising, were found to have no correlation. Two
others that were found to have significance and subsequently added
as options to the risk calculator, were the PCA3 urine marker and a
detailed family history. When using the risk calculator, you can select
these options to enhance your calculation.
These theories and technology can be applied to other cancers and
the diagnostic dynamics surrounding them. The team is looking at
livery of individualized, patient-directed medical care.
That men can have prostate cancer with a low PSA and be cancer
free with an elevated PSA is exactly why the SABOR program is so
important. Age, race, ethnicity, family history, genetics, and other
factors play a role in the risk for developing the cancer and also the
risk for which form of prostate cancer one might develop. SABOR
has created the most sophisticated, yet easy-to-use, tool available for
estimation of prostate cancer risk.
Thirty million men in the United States will develop prostate can-
cer. That number will be nearly 300 million worldwide. We do nearly
1.5 million biopsies a year in the U.S., perhaps as many as 100,000
are unnecessary. Nearly the same number of men are not biopsied
but should be. These statistics underscore the SABOR goal: to biopsy
those who truly need it, and leave the ones who don’t alone. SABOR
is the hub around which this equation will be solved, with their
prostate cancer risk calculator and other research becoming an inte-
gral part of healthcare in the United States.
Learn more about SABOR and the Prostate Cancer Risk Calcula-
tor, including an excellent video by Dr. Thompson explaining the
calculator’s use and benefit, visit http://myprostatecancerrisk.com.
Francisco González-Scarano, MD, is dean of the
School of Medicine, vice president for medical affairs,
professor of neurology, and the John P. Howe III,
MD, Distinguished Chair in Health Policy at the
University of Texas Health Science Center at San An-
tonio. His email address is scarano@uthscsa.edu.