WHAT HAPPENS TO CANCER CELLS OVER TIME

Some men who opt for watchful waiting take solace in the fact that their cancer cells are well-differentiated. But unfortunately, just because you have well-differentiated cancer cells today does not mean they’ll stay that way forever. There are two concepts here; one is genetic drift. As a cancer progresses—as its cells double again and again—the DNA becomes less stable. The cancer develops new mutations; it becomes more aggressive. As the tumor progresses, well-differentiated cells deteriorate into poorly differentiated cells. The other concept is heterogeneity, or clonal selection. By the time a prostate cancer is large enough to be diagnosed clinically, its cell population is mixed—a diverse group of cells, all jockeying for position in one location. In this varied group are both well and poorly differentiated cells, cells driven by hormones and cells untouched by hormones. And although an initial biopsy may find well-differentiated cancer cells, almost certainly some poorly differentiated ones have mingled in there as well. With time and further growth, these poorly differentiated cells grow at a faster rate than do their more sedate, better-differentiated counterparts. Eventually, they will outpace the stately progression of the well-differentiated cells and dominate the tumor. So a well-differentiated cancer, one that’s localized to the prostate, may be only a temporary condition. And unfortunately, we can’t tell which well-differentiated cancers are going to stay that way.

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