The most common type of prostate cancer has two different ways of developing in the body, researchers have discovered, opening up new options for identifying which patients need treatment.

Prostate cancer is the most common type of cancer in men, with One in eight will be diagnosed with the disease during their lifetime. Most prostate cancers are adenocarcinomas – A type of cancer that forms in the glandular tissue that covers certain internal organs. But although the disease can kill, for many patients the risk is low.

Professor David Wedge, from Manchester Cancer Research Centre, who led the study, said: “The key problem in prostate cancer is identifying the 15 per cent of more aggressive cancers that spread to other organs and are indeed fatal.”

He said: “If we can identify those people, we can give them stronger treatment… and you can leave the 85% of men alone. This is important because the surgery itself has many side effects.

Now, Wedge and colleagues say they’ve discovered a new way to classify adenocarcinomas that may help them do just that.

Writing in the journal Cell GenomicsThe researchers report how they sequenced the genomes of 159 patients with prostate adenocarcinoma. They then used three different approaches – including artificial intelligence (AI) – to analyze the patterns in the genome, including the way the DNA breaks down and the order in which certain genetic changes occur.

All three approaches show the same result: prostate cancers fall into two main groups – or “evotypes” – related to how they change in the body over time and the mechanisms involved.

Most importantly, when the researchers looked at the results of blood tests done after the patients had been treated, people with one evotype were twice as likely to show signs of recurrence of the disease compared to the other.

“Usually those people will actually have metastasis,” Wedge said. [so] The cancer has spread to other organs.

The team’s findings suggest that genetic testing could be used to determine whether patients with prostate adenocarcinoma have more, or less, aggressive evotypes, so that treatment can be better tailored to them and delivered sooner.

Wedge said it is now important to determine whether evotypes are associated with patient age and ethnicity, and the team is looking at whether other types of cancer have evotypes.

Professor Joe O’Sullivan, consultant prostate cancer oncologist at the Northern Ireland Cancer Center in Belfast, who was not involved in the study, welcomed the findings.

Identifying two different types of prostate cancer based on their genetic evolution could open up new opportunities for both treatment and drug discovery, he said.