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New tests that show aggressiveness of PC tumors?

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Posted 8/21/2016 2:12 PM (GMT -5)
New tests that show aggressiveness of PC tumors

I have a low grade prostate tumor. All my info has been posted in the past and have gotten some very informative information from this group. Currently I am under what we all know as the "watchful waiting program" which means the Dr. wants me to have another biopsy in about six months.

I am going in for a PSA test six months after my last biopsy this Friday. My PSA three months after the biopsy was actually lower than before which I thought was odd.

But I know that can fluctuate.

My real question is how many of you out there have had their blood sample screened using the "Prolaris" procedure or one of the other new tests that supposedly can accurately show how aggressive the tumor is and the percentage of chances of it spreading VS it staying the same.

I've read some research on this new test....I'd like to hear opinions from those in a similar situation
(without going into much detail I have one tumor that is a 3+3 so a gleason score of 6)
on Finesteride before biopsy psa 3.1 3 months later it was 2.7) It slowly increased from 2.3 to 3.1 over the previous year....slow change.

If my PSA is in fact still lower....this test shows its not aggressive.....
perhaps my watchful waiting will only include psa....this new test....a 3D dopplar ultrasound...and possibly an MRI every year. Not another Biopsy where the Dr. wants to compare the tissue with the sample taken a year earlier. If everything is the same then an MRI every year. But with this new test perhaps I can forgo anther biopsy.

Opinions?
Posted 8/21/2016 2:45 PM (GMT -5)
Prolaris (or Oncotype Dx) is usually a very expensive way of knowing what you already know. But if you can afford the steep price tag ($3000-$4000), it can add to your confidence. Your first follow-up biopsy on AS has to be a biopsy. mpMRI or CDUS targeted or template mapping biopsies are all good. After that, your biopsies can depend on your PSAs and what the previous biopsy showed. I think it's a very good idea to stay on finasteride while you're on AS. PHI, instead of just PSA, may be a good idea as well.

- Allen
Posted 8/21/2016 6:13 PM (GMT -5)
Greetings Allen

You always have my ear!

So are you saying that its not necessarily imperative that I have another biopsy as the Dr. suggests in order to compare the tissue from the first one I had. He wants to do it in one year from the first one. If the PSA is not rising would a 3T or the best mri be enough.

As far as the Prolaris test....wouldn't it reveal something you don't know....that the cells in the tumor one has a greater chance of the cancer becoming aggressive? Isn't that the point...that you don't know if your tumor will stay the same or become aggressive....this test shows you the percentage of chance of it happening.

How accurate it is or weather its worth it is another story.

Am I missing something about this test? I've also read there are other less expensive tests...perhaps not as accurate.
Posted 8/21/2016 6:28 PM (GMT -5)
There was a paper not too long ago that suggested that a confirmatory biopsy may not be necessary for some cases. Based on %PCA, no. of postive cores, Gleason score, progression of gleason score, DRE etc. The criteria ,as I recall, put the risk at very low or low at the worst by NCCN standards.
Posted 8/21/2016 7:08 PM (GMT -5)
fuzzboxman,

I'm not saying Prolaris won't change your treatment decision, I'm just saying that with your very low risk features, the chances of Prolaris making a difference are small. Prolaris is accurate. I'm just saying that normal AS procedures (tracking PSA and f/u biopsy) are likely adequate when the initial diagnosis is very low risk. Your low PSA, low stage, low Gleason score, and very low disease volume are prognostic for staying on AS for a long time. I'm just saying that Prolaris is an expensive tool for most likely telling you what you already know.

And I'm absolutely NOT saying that you can safely forego a first follow-up biopsy within a year - that is absolutely essential to good AS management. It is very easy to miss significant cancer on a single biopsy. The follow-up biopsy should be targeted using mpMRI or CDUS (read by a top-rate radiologist) or a transperineal template mapping biopsy.

- Allen
Posted 8/21/2016 7:42 PM (GMT -5)
Allen

Thanks for the response. I get what you are saying. This first biopsy was the most advanced fusion targeted biopsy and so will the follow up.

The DR. said the reason for the follow up biopsy was not missed cancers on the first one...which certainly is possible...he said without examining the actual tissue itself and comparing it to the tissue obtained a year earlier you can't obtain enough pertinent data to be certain treatment is not needed at this time. I suppose seeing no change in the MRI is not sufficient. I was hoping it might be.

Informed opinions are really appreciated.

Mr. Fuzzboxman.....that' for a guitar by the way....a fuzzobox.
Posted 8/21/2016 8:04 PM (GMT -5)
It is unlikely that any two biopsy cores on subsequent biopsies will sample exactly the same part of the same tumor. Prostates move and change over time. On AS, what you are looking for is any GS 4+3.
Posted 8/21/2016 10:04 PM (GMT -5)
Fuzz, what you are doing is 'active surveillance", not "watchful waiting". We have had several discussions here differentiating between the two protocols.

How old are you? Believe me, you don't want to be putting your body through the stress of biopsies every year for many years. Discuss this with your doctor. My plan changed at age seventy from a yearly MRI and biopsy to one or the other every two years.

Regarding the cost of Prolaris and OncotypeDX, I posted cost information similar to TA's a few months ago, and another member replied that the current costs were in the low hundreds. So, you may want to further research that.
Posted 8/22/2016 12:19 PM (GMT -5)
I read several places that the cost of Polaris and Oncotype testing is in the $3,000 to $5,000 area. The actual cost to the patient will depend on their insurance and whether it is reimbursed. If it is and the cost is a few hundred as AS stated, then by all means go for it. A small price for the information. I have a feeling though that a low volume G6 would have difficulty getting it approved. As TA said, that is not who needs the test or can really benefit significantly from the information. So, Fuzz, call your doc and see if he can get the test approved.
Posted 8/22/2016 1:59 PM (GMT -5)
While on AS I had both Prolaris and OncotypeDx tests without any charges. Apparently the vendors were offering their tests for free in order to gather more patient data, at least that's what my doctor said. But free or not, they provided no information that changed treatment decisions, as the doctor said the results were just "consistent" with other indicators.
Posted 8/22/2016 3:44 PM (GMT -5)
The cost of my OncotypeDx was approved by my insurance company after an appeal, my copay was $35. I believe my cost would have been $100 had the insurance company refused to pay for it.

My Prolaris Test (a few years back), I believe, was absorbed by Myraid Genetics as part of their data collection. I think they have a max out of pocket at around $400.
Posted 8/22/2016 6:59 PM (GMT -5)
Thanks for the info

Those prices listed above seem a lot less than others reported. I don't know if my insurance would cover it.... but I would pay 100 bucks out of pocket easy.....just for the extra data.
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