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Prostate Cancer

This Gene Test May Help Prostate Cancer Patients Bypass Surgery

A new prostate cancer gene test can reduce the number of men who need prostate cancer surgery. Genomic Health announced the availability of the Oncotype DX prostate cancer test. The test can strongly predict disease aggressiveness, helping patients and physicians make more informed decisions about how to proceed with prostate cancer treatment.

Oncotype DX is a multi-gene test that looks at 12 genes that are associated with how tumors progress. This biopsy-based test was developed and validated in seven studies that included over 1,100 patients. When patients combine the score of this prostate cancer gene test with their biopsy Gleason score, they can determine whether their cancer is aggressive or slow growing. This allows patients to personalize their prostate cancer treatment.

The new prostate cancer gene test gives men the opportunity to decide if watchful waiting and active surveillance is the right action for them or if they are at risk of a more aggressive prostate cancer and should have prostate surgery.

One man in six is diagnosed with prostate cancer, and one man in 36 dies from it. Since many prostate cancers do progress slowly, a lot of men end up having prostate surgery for slow-growing tumors. According to Genomic Health, even though multiple guidelines recommend active surveillance for low-risk prostate cancer, currently 90% of low risk patients choose to undergo immediate treatment such as radical prostatectomy or radiation, despite there being less than a 3% chance of their low-risk cancer progressing and becoming deadly. Radiation and surgery have potential side such as impotence and incontinence. The prostate cancer gene test can help men get more information about their personal prostate cancer prognosis, allowing them to avoid aggressive treatment for low-risk prostate cancer and to maintain a higher quality of life.

Genomic Health expects to triple the number of men choosing active surveillance due to this new prostate cancer gene test. “The results of our study showed that the individual biological information from the Oncotype DX prostate cancer test tripled the number of patients who can more confidently consider active surveillance and avoid unnecessary treatment and its potential side effects. The test also identified a smaller number of patients who, despite seemingly low-risk clinical factors, had more aggressive disease and, would suggest that they consider immediate treatment,” said Peter Carroll, M.D., MPH, professor and chair, Department of Urology, UCSF and principal investigator of this validation study.  “With these new study results, I believe we may be able to significantly increase the use of active surveillance, which has been limited to some extent by the absence of a validated genomic tool to more accurately distinguish low and high risk disease at the time of biopsy.”

What is active surveillance?

Watchful waiting and active surveillance are similar plans for treatment of nonaggressive prostate cancer, but there are some differences. Watchful waiting patients tend to be over 70 and have very low-risk cancers that are not likely to become aggressive or lead to death. Patients do not take action to monitor their prostate cancer. Active surveillance also involves watching, but it includes taking action through carefully and consistently monitoring a man’s prostate cancer without surgically removing it. Patients who choose active surveillance continue to see their doctor regularly and get regular PSA tests, clinical exams, and sometimes prostate biopsies or MRIs to watch for signs that the prostate cancer is progressing. Patients who choose these methods should look to diet and lifestyle changes that can help protect their prostate health and help keep them from developing more aggressive tumors.

Read more in our Prostate Cancer Health Center.


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