The cost and the effectiveness of genomic testing for prostate cancer risk

As regular readers will be well aware, there are now several different tests available that can be used to assess risk for low- and very low-risk forms of prostate cancer at time of diagnosis (as opposed to clinically significant forms that need early treatment).

These tests include the following:

and there are newer ones in development all the time now.

Whether any of these tests is actually any better than the others at predicting the likelihood of low- or very low-risk prostate cancer that can be well managed on active surveillance is utterly unknown at the present time.

However, what we do now know is that these tests are effective at helping men to decide that active surveillance is a reasonable option for the initial management of low- and very low-risk forms of prostate cancer, and that at least one of them is cost-effective over the first 180 days post-diagnosis.

Albaba et al., in Reviews in Urology, report data from a study of 180 patients, all diagnosed and managed at a specific clinical practice in New York State after 2013. All the patients met criteria for at least favorable intermediate-risk  prostate cancer at time of diagnosis. All the patients were covered by a particular health insurance provider (allowing detailed analysis of cost data). And the patients came from two different but comparable groups:

  • 100 patients were diagnosed between February and December 2013 and were retrospectively identified from patient records; among this group
    • 25/100 (25 percent) had very low-risk disease.
    • 46/100 (46 percent) had low-risk disease.
    • 29 /100 (29 percent) had favorable intermediate-risk disease.
  • 80 patients were recruited into a prospective study between July 2, 201, and March 11, 2016; among this group
    • 23/80 (29 percent) had very low-risk disease.
    • 28/80 (35 percent) had low-risk disease.
    • 29/80 (36 percent) had favorable intermediate-risk disease.

What Albaba et al, were able to show was that, compared to the decisions about the men in the historic, non-genomically tested group of men,

  • Genomic testing data using one of the above-mentioned tests among the 80 prospectively recruited patients
    • Increased the willingness of patients with very low- and low-risk prostate cancer to elect active surveillance as first-line management (from 38 to 59 percent).
    • Lowered the number of patients with very low- and low-risk prostate cancer who elected immediate surgery (from 35 to 25 percent)
    • Lowered the number of patients with very low- and low-risk prostate cancer who elected immediate intensity-modulated radiation therapy (IMRT) (from 25 to 12 percent)
  • There was a consequent average cost-saving over the first 180 days of treatment of $2,286 inclusive of the cost of the genomic testing.
  • Using GPS increased physician confidence in treatment decision making among the genomically tested patients.
    • In 91 percent of cases, physicians indicated increased confidence in decision making after testing.
    • In 90 percent of cases, physicians found the test data useful in clinical practice.

None of this can tell us whether any one of the list of above-mentioned tests is “better” than any other in helping patients and their doctors to make “the right” decisions about first-line management of their prostate cancer. On the other hand, it is clear that this type of data does seem to help both patients and their doctors to feel a good deal more comfortable about considering and suggesting active surveillance as a first-line management option for men with low- and very low-risk disease.

One might also reasonably assume that a $2,000+ cost-saving per patient in the first 180 days post-diagnosis would make the average payor feel more comfortable about covering the costs of this type of test for many prostate cancer patients.

4 Responses

  1. I had the Oncotype test a bit over a year ago. My lab results were two cores of 5% and 10% Gleason 6 out of 16 cores taken. The Oncotype score was 28 … very low risk. In September, biopsy results were four cores of Gleason 8,ranging from 5% to 30% and three cores of Gleason 6 ranging from 20% to 40%. The test may be fine for the sample submitted but can lead to false security because a single biopsy may have missed tumors or new tumors may develop.

  2. Dear 833man:

    … And your observations are 100% accurate.

  3. Hi 833man,

    Did you have the Oncotype test on your September biopsy cores? If so, what were the results? If not, why not?


  4. Dear Bald Eagle:

    I did not do the test on the September biopsy cores. I understand that the attraction of the test is to confirm that one is a decent candidate for active surveillance. Once I got Gleason 8 lab results, that prospect was out the window because I need treatment.

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