Not all prostate cancers are alike. Some are fairly indolent and do not require aggressive treatment. These cancers can often be managed with active surveillance, in which men are followed closely with treatment reserved for those with signs of disease progression. Others are more aggressive and require definitive treatment.
Typically this distinction is fairly straightforward. The PSA, physical exam, and most importantly the Gleason score of the cancer found on biopsy combine to provide a clear picture of the cancer’s aggressiveness.
Sometimes, however, it is not so obvious. Many patients with prostate cancer fall into a gray zone. Their cancers may have certain features suggesting they are indolent and slow-growing as well as other features suggesting more aggressive disease. If these men are to consider active surveillance and forego aggressive treatment, then it is critical to very accurately understand their cancer. Risk stratification, meaning separating men into different levels of risk for cancer progression or treatment failure, is critical.
Relatively new prostate cancer tests called Prolaris and Oncotype DX have the potential to improve risk stratification. These tests are tissue-based tests (performed on prostate biopsy tissue) to evaluate the biologic activity of cancers at the molecular level and provide insight into the likelihood that prostate cancer will grow and spread. This can often help us decide between active surveillance and immediate treatment.
Prolaris, analyzes tumor growth characteristics with a 46 gene panel which specifically includes cell cycle proliferation genes. This test provides a fairly accurate 10-year prostate cancer-specific mortality risk and helps provide a personalized risk assessment.
The Oncotype DX is a genetic test that measures the expression of 12 cancer-related genes, providing information on the biological activity of the tumor. The test provides a Genomic Prostate Score, which gives insight to the likelihood of cancer progression.
At Sarasota Prostate Care, we often utilize Prolaris and Oncotype DX to provide better risk stratification for our patients.