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The Wall Street Journal had a story today about a test that might distinguish between low risk and aggressive forms of Pca.
Wednesday, May 8, 2013 As of 12:34 AM EDT
• Updated May 8, 2013, 12:34 a.m. ET
Prostate Test Could Cut Need For Surgery
By RON WINSLOW
A new genetic test can help distinguish between aggressive and low-risk forms of prostate cancer, a study suggested, offering a tool that could enable many men diagnosed with the disease to delay or forgo surgery to treat it.
A new genetic test can help distinguish between aggressive and low-risk forms of prostate cancer, which could enable many men to delay or forgo surgery to treat it. Ron Winslow reports on Lunch Break.
More than 220,000 men in the U.S. are diagnosed with prostate cancer each year, thanks in part to wide use of a screening test called PSA. Elevated PSA levels lead to biopsies, which can detect the cancer.
But such screening often finds cancer that is very slow-growing, and many public health officials contend this leads to overtreatment of cancers that would have been unlikely to spread and cause problems.
Indeed, so many low-risk cancers are detected that PSA tests have come under fire. Groups such as the American Cancer Society and the U.S. Preventive Services Task Force recommend against routine screening in healthy men. Unnecessary surgery and other treatments are costly and risk potentially life-changing complications for patients such as impotence and incontinence.
For men in whom cancer is detected, doctors currently seek to identify the risk of spread based on such factors as age, the size or volume of the tumor, the PSA level and a measure called the Gleason score.
A course of "active surveillance" in which the tumor is regularly monitored for changes is recommended for men with low-risk prostate-cancer tumors.
But "only 10% to 15% of men are getting active surveillance," said Peter Carroll, a surgeon and head of urology at the University of California San Francisco. "Most men, no matter what their risk is, get treated."
Thus, researchers have sought better ways to determine which men need aggressive treatment like surgery and which can safely do active surveillance, also known as "watchful waiting."
The new test, being developed by Genomic Health Inc. GHDX +6.41% in Redwood City, Calif., is based on a panel of 17 genes, including 12 associated with tumor growth and proliferation. When performed on biopsy tissue in a study involving 395 patients, the test provided data that researchers said would help predict which patients had high risk of their cancer spreading and which could have safely avoided or put off treatment.
In one analysis, the study found that the number of men and their doctors who could confidently pursue an active surveillance strategy rose to as high as 26%, based on the genetic test, compared to 10% with conventional assessment.
Based on the findings, which are being reported Wednesday at the annual meeting of the American Urological Association in San Diego, Genomic Health is launching the test with a list price of $3,820.
The company markets other genomic diagnostic tests, including one to help breast-cancer patients decide whether to avoid chemotherapy that has been used 350,000 times since its launch nine years ago, the company said.
Dr. Carroll led the current study to validate the Genomic Health test. The men were all considered candidates for active surveillance, but underwent surgical removal of their prostates as part of the study.
Doctors said more research is needed—and is under way—to determine how the test will best fit into clinical care.
"This is an important step," said Dr. Carroll. "My hope is over the next couple of years we will determine whether a gene [profile test] really has an impact and changes treatment patterns and patient satisfaction." He is principal investigator of the new study, which was funded by Genomic Health.
David Penson, professor of urologic surgery and medicine at Vanderbilt University, who wasn't involved with the study, called the findings "definitely promising, but they're preliminary."
He added that "with additional studies, this could make a real difference, but I'm not ready to make every single decision based on this."
Write to Ron Winslow at ron.winslow@wsj.com
A version of this article appeared May 8, 2013, on page A8 in the U.S. edition of The Wall Street Journal, with the headline: Prostate Test Could Cut Need For Surgery.
Unfortunately, in my 7 years of active research while pursuing Active Surveillance, I've become a bit skeptical about press articles such as the Wall Street Journal blurb on Genomic Health Inc's 17-gene panel. Increasingly we live in a world where medical research seems aimed at quick investment turnover rather than true breakthroughs with long-term results. Even press releases on cancer 'breakthroughs' from academia too often turn out to be adverts luring investment dollars rather than honest assessments.
Those of us on Active Surveillance (AS) yearning for improved biomarkers to predict cancer aggression only need to recall the empty promise a few years ago for EPCA2, which seemed to have excellent early results with high specificity for prostate cancer. Only to turn out to be an empty promise at best and an academic hoax (lawsuits pending) at worst.
Even PCA3 is turning out to have questionable value for accurate individual prediction of prostate cancer aggression. We still have to depend upon clues from a number of imprecise indicators, including too-frequent repeat biopsies, to guide us in assessing our status during AS.
Not to discount the value of AS as an alternative for immediate treatment for early diagnosis of low-risk prostate cancer-- I have no regrets about my own treatment deference for 7 years. But, the new biomarkers 'on the horizon' need robust clinical trials before they have prove to be of real value to those of us with our disease.
I agree with you Jon, money clouds validity, especially in the WSJ who pump and dump companies constantly. However, it may provide another data point, that along with PSA monitoring, DRE, Prostate MRI, Color Doppler may help lead someone to a better informed decision.
Even the recommendation of AS, is it a way to save medical costs or unnecessary side-effects? Perhaps both
Read your post with interest, and that you have been on AS for 7 years. What was your initial Gleason score, how many cores were positive, at what percentages, and what was and is your PSA?
I was diagnosed in May 2013, with Gleason 3+3=6, T1c, 5 of 12 positive cores, at 5, 10, 15, 40 & 50%, and a PSA of 4.5. A second opinion on the biopsy suggested a bit of 3+4 in one core, so I'm awaiting an opinion from Estein/Johns Hopkins.
For most of the summer, I was committed to AS, but now I am beginning to waver. Here's why: 1) Five cores, including two at 40% and 50%, suggest that there is not an "insignificant" amount of cancer. 2) My PSA has been steadily rising for about the past 5 years, from 2.5, 3.2, 3.5, 3.9 and 4.5 in the past four years. 3) If i end up needing treatment, and surgery in particular, any growth in my cancer would further compromise the chances of success of nerve-sparing (because the surgeon would need to cut closer to the nerves). 4) Almost one-third of Gleason 6s turn out to be 7s, which is less ideal for AS.
As a "quality of life" guy, I had long held to the belief I was in that vast majority of men who would be able to outlive their PC (I am 58), but lately have begun to have my doubts.
