Recently, there has been more un the press about personalized medicine.  Typically, this is referring to genetic sequencing that can see risk for development of different diseases like Parkinson, Cystic Fibrosis, Alzheimer’s, Type 1 Diabetes and heart disease in men to name a few.  But how do we use Personalized Medicine in reference to prostate cancer?  The answer comes in testing the actual prostate cancer tissue for genetic and molecular markers.

There are now many commercially available Prostate Cancer tissue tests.  Each has it’s place in the care of the patient.  Each answers different questions about the patient or cancer. Some are covered by most insurers and others are not.  There are test to look at tissue and stratify risk of prostate cancer that was not found by the biopsy.  There are test which look at Prostate Cancer tissue and give the chance of living 10 years from the disease.  Your physician should look at your situation and decided which is the most appropriate for your individual situation.

Lets first look at the test for risk of having prostate cancer. These test are generally blood tests.  PSA is a good test but has limitations as it can be elevated in the setting of non cancerous conditions.  Percent Free and total PSA help distinguish men with a PSA in the 4 to 10 range who are more likely or less likely have prostate cancer.  Prostate Health Index is a calculated number based on PSA, free PSA and p2PSA and has more sensitivity on finding men at higher risk of prostate cancer then PSA and Percent Free PSA.   The 4Kscore test “provides a percent risk score that is your chance of having aggressive prostate cancer”.  This means IF YOU HAVE PROSTATE CANCER this test help see if it is aggressive.  This test will answer and quantify clinically relevant questions like the Positive Predictive Value (PPV), Negative Predictive Value (NPV) and risk of delayed diagnosis of aggressive cancer if biopsy is not performed.  The Apifiny test looks at 8 antibodies release in the setting of Prostate Cancer. The PSA must be above 2.5 to be valid. It report in a binary fashion of lower or higher risk.  If the test returns higher risk then the man has a 1:3 chance of prostate cancer.  In men who have had a biopsy but cancer was not found, if there is high suspicion based on clinical findings one can order Confirm MDX on the tissue.  This look for epigenetic markers as these can change in the tissue field surrounding a prostate cancer focus within the gland.

Then we have test on prostate cancer tissue once a biopsy has been done.  The Prolaris test will report the 10 year disease specific survival. It looks at cell cycle progression and data to predict the chance of prostate cancer death.  The Oncotype Dx Assay is another test for risk assessment based on the indiviuals tumor biology.  It reports a Genomic Prostate Score (GPS) that can be translated into favorable or aggressive disease.

In using these test we can have more information about who might be a better candidate for biopsy and who doesn’t need the biopsy.  And once prostate cancer is diagnosed, who should be treated and who may be better with active surveillance.

Tags: cancer screening, personalized medicine, prostate biopsy, Prostate cancer, prostate cancer aggressiveness, Prostate Cancer screening