By James DeGregori and Robert Gatenby
This year at least 31,000 men in the U.S. will be diagnosed with prostate cancer that has spread to other parts of their body, such as bones and lymph nodes. Most of them will be treated by highly skilled and experienced oncologists, who have access to 52 drugs approved to treat this condition. Yet eventually more than three quarters of these men will succumb to their illness.
Cancers that have spread, known as metastatic disease, are rarely curable. The reasons that patients die despite effective treatment are many, but they all trace back to an idea popularized in 1859 by Charles Darwin to explain the rise and fall of species of birds and tortoises. Today we call it evolution.
Think of a cancer cell like Darwin’s Galápagos finches, which had slightly different beaks on various islands. Finches eat seeds, and seeds on each island had different shapes or other characteristics. The bird with a beak shape best matched to the local seed got the most food and had the most offspring, which also had that particular beak shape. Birds with less adaptive beaks did not make it. This natural selection ensured that different finch species, with various beaks, evolved on each island. The key is that when two groups of critters compete in the same small space, the one better adapted to the environment wins out.
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