There are several validated prognostic tests on the horizon that hold the promise to support personalized prostate cancer management by providing additional information about cancer aggressiveness. These tests approach the problem by assessing the activity of your genes (genes that control the behavior of the tumor in your body) to provide valuable information about your risk; information distinct from the information provided by prostate specific antigen (PSA) testing or tumor grade (Gleason score).
Development of new and individualized ways to understand patient risk in prostate cancer is important because we know that not all tumors behave the same. Gleason score, for example, is determined by looking at morphologic features of your tumor. This valuable but subjective measure can provide a prognostic picture of your cancer but doesn’t always predict accurately the behavior of your tumor. We know, for example, that two patients with Gleason 7 may have very different outcomes. In addition, PSA has proven a less reliable tool to diagnose prostate cancer or predict the aggressiveness of disease. As such, current clinical assessment tools often don’t tell the whole story.
New tests use the science of genomics (the specific role your genes play in your health and disease) to help patients and their doctors make more informed decisions about their management and treatment options at multiple points in time, including helping to understand whether patients:
• are safe to be on active surveillance
• can justify more aggressive treatment
• may benefit from an initial aggressive approach with new drugs or chemotherapy
• should consider any additional treatment such as hormonal blockade after undergoing radiation or surgery
The goal is that by offering tests that take advantage of genomic science, patients will be armed with additional specific information to help them, their doctors and their loved ones make more confident decisions about their care. These tests will play an important role in ensuring that the right patients get the right treatment at the right time. In other words, they have the potential to support treatment decisions in such a way that we more accurately identify the patients who can safely avoid additional treatment and conversely, those who truly require earlier, more aggressive treatment.
One such test, called Decipher TM aims to do just this. Decipher was developed by GenomeDx Biosciences for patients who have chosen surgery, or radical prostatectomy to treat their prostate cancer. The test measures the activity of a number of prostate cancer genes to provide an individualized assessment of the risk of cancer returning and spreading after surgery. Current treatment guidelines recommend additional therapy for men at risk for their disease coming back. This represents around half of all patients undergoing surgery in the US today, but in reality, the majority of men considered high risk by clinical guidelines don’t have to worry about the return of their disease – Decipher helps identify those men.
Tests such as Decipher have the potential to play an important role in the management of patients after surgery by better directing decisions about the need for additional treatment such as hormonal blockade or radiation and by alleviating the anxiety inherent in making those decisions. The future is now: individualized medicine guided by personalized test results. The days of managing patients with information derived only from large population studies are over. Utilizing the specific information provided by tests such as Decipher will enable more individualized prostate cancer management one patient at a time. Each patient is unique; it’s time we started treating them that way.
More information about the Decipher test can be found by visiting www.genomedx.com For more information about this article please contact:
Dr. Israel Barken, Phone: 619-906-4700
Penelope J Wood, MBA
Elai Davicioni, PhD