Genomic Testing for Prostate Cancer
Prostate cancer can be confusing. While prostate biopsies are the gold-standard in prostate cancer diagnosis, it’s far from perfect.
There seems to be about a 25% chance of false negatives from prostate biopsies. That is, the result of a biopsy may appear that there is no cancer in the gland but there’s indeed hidden cancer in there. Essentially, the biopsy needle misses the suspicious tumor.
Further, a prostate biopsy result may come back as a low, insignificant grade of Gleason 6 where there might be a more aggressive type in the prostate of a Gleason 7 or higher.
Prostate cancer and medicine in general involve probabilities like any other sector in life. And while the “shoot-and-miss” component of the process has been greatly reduced by targeted biopsies, this method is not totally perfect, either.
So what can you do?
Welcome to Genomic Testing.
What is Genomic Testing for Prostate Cancer?
You and your physician want an answer to a very important question: Do you have the type of prostate cancer that can progress and eventually kill you or do you have the indolent type that will never grow, spread and lead to an early death?
Testing can further reduce your chances of missing an aggressive cancer that can be cured successfully if found early. And it can help you make an informed decision as to the best treatment process (such as deciding if an aggressive, mainstream approach is necessary at all).
There are four labs that offer Genomic Testing: Decipher® from GenomeDx (San Diego, CA) , Oncotype® from Genomic Health (Redwood City, CA) , Prolaris® from Myriad Genetics (Salt Lake City, UT) and Confirm MDx® by MDx Health (Irvine, CA)
Here’s a summary of the genomic test available for prostate cancer and how they help:
Company – GenomeDx
Name of Test – Decipher
When is it performed? – After surgical prostate removal
What is analyzed? – The prostate gland
What it tells you? -Risk of cancer spread in 5 yrs or in 3 yrs after PSA recurrence
What is the benefit? – Tells you if additional salvage therapy needed
Company – Genomic Health
Name of Test – Oncotype®
When is it performed? – After biopsy
What is analyzed – Prostate tissue from biopsy
What it tells you? = A genomic prostate score (GPS) showing the likelihood of having more aggressive cancer than the biopsy reports
What is the benefit – Tells you if Active Surveillance is an option or if immediate treatment is required
Company – Myriad Genetics
Name of Test – Prolaris®
When is it performed? – After biopsy or surgical removal of the prostate
What is analyzed – Prostate tissue from biopsy or prostate gland
What it tells you? -Predicts 10-year survival with conservative management or chances of biochemical recurrence
What is the benefit – Tells you if Active Surveillance is an option (after biopsy) or if immediate treatment is required (after prostatectomy)
Company -MDx Health
Name of Test – ConfirmMDx
When is it performed? – After a prostate biopsy
What is analyzed – It detects an epigenetic field based on DNA methylation
What it tells you? – If there is a “halo effect” only present in cancer lesions from a biopsy
What is the benefit? – It confirms if a negative biopsy is truly negative or if there is hidden cancer not found by the biopsy
What Should you do?
Your physician may or may not automatically order these tests. He or she may not know about them or simply are stuck in their old ways of practicing. Either way, bringing it to your doctor’s attention may be the right thing to do so you, your physician and your family can make an informed decision on how to proceed.
Also, based on these tests you may determine how aggressive you will apply the lifestyle interventions we talk about often on this website.
Daneshgari F, Taylor GD, Miller GJ, Crawford ED. Computer simulation of the probability of detecting low volume carcinoma of the prostate with six random systematic core biopsies. Urology. 1995;45:604–609.
Erho N, Crisan A, Vergara IA, et al. Discovery and validation of a prostate cancer genomic classifier that predicts early metastasis following radical prostatectomy. PLoS One. 2013;8:e66855.