Prostate cancer is one of the most common cancers afflicting men; nearly 175,000 men will be diagnosed with prostate cancer this year alone. In the past, this has inspired doctors to take an aggressive approach to treatment by default.
“The majority of men that have prostate cancer have lower risk prostate cancer,” says Rick Baehner, M.D., chief medical officer at Genomic Health, a diagnostic company addressing both the overtreatment and optimal treatment of cancer with genomic-based tests. “They will die with their cancer — not from their disease. Unfortunately, the vast majority will choose to have a prostatectomy for fear of their cancer being potentially more aggressive.”
“There are a lot of misconceptions about the disease,” says Wendy Poage, MHA, president of the Prostate Conditions Education Council (PCEC). “Prostate cancer does not only impact older men; and there is a significant life-saving benefit to screening and early detection, especially for at-risk men.” PCEC reaches more than 400 million people each year with information about prostate cancer and men’s health, and provides free and low cost PSA tests throughout the country. To learn more, visit www.prostateconditions.org or call 1 (866) 4-Prost8.
The most common screening test for prostate cancer is the prostate-specific antigen (PSA) test. “Most men are sent to a urologist because of an elevated PSA,” says Richard C. Sarle, M.D., a urologist with Sparrow Medical Group Urology. “They get a biopsy, and they get a diagnosis of prostate cancer. Then the urologist will place the patient into a risk category. Treatment options are based on that risk.”
The difference in approach between high-risk and low-risk patients is stark. “If someone’s diagnosed with low-risk disease, the mortality from prostate cancer at 10 years is probably less than 1-2 percent,” says Sarle. “The problem that we’ve had historically is that the initial risk assessment has been fundamentally flawed. If we put them in the wrong category, we end up making incorrect decisions, and that’s where Genomic Health’s GPS test has come into the mix.”
The Oncotype DX Genomic Prostate Score® (GPSTM) is a genomic test offering an extremely accurate prediction of the level of risk involved with prostate cancer. “The GPS test looks at 17 genes and their expression,” explains Baehner. “Those levels tell us whether or not that is an aggressive or non-aggressive tumor, so the patient can be selected for monitoring — known as active surveillance — if it’s not aggressive.”
“What’s special about the GPS test is that the result is representative of the entire prostate,” says Poage. “With a biopsy, the patient often worries about if a more aggressive cancer was missed — they’re worried about what might be hiding. The GPS test gives patients and doctors more information to help make a decision — and at a minimum it confirms the decision to treat with active therapy versus active surveillance.”
This has greatly reduced over-treatment of low-risk cancers. “Twenty years ago, almost everyone with prostate cancer — 98 percent of patients — were treated in some way,” says Sarle. “Today, that number is getting closer and closer to 50 percent. For a large number of low-risk patients, their decision is to enter active surveillance.”
Empowering urologists and patients
Avoiding over-treatment has a real impact on a patient’s quality of life, and can also avoid the often-unpleasant side effects of most prostate cancer treatments. “There may be side effects to treatment,” notes Poage. “There’s a risk of impotence and incontinence, but it’s a decreasing risk as the tools and surgeries and techniques that we have get better. Probably the biggest misconception I hear is that if you have cancer it needs to be removed. We remind patients and their families that just because you get diagnosed doesn’t mean you need to get treated. Monitoring the cancer is often a great option, and that’s where tests like the GPS score make a big difference.”
In the end, the Oncotype DX® GPS test is making treatment easier and more effective. “This is an extremely exciting time of moving from one-size-fits-all to an era of personalized medicine,” says Baehner. “Targeted therapies, better molecular tools, and, ultimately, better outcomes for physicians and patients.”
Jeff Somers, [email protected]