Genomic prediction of risk for biochemical relapse post-surgery

Yet another genetic/genomic test (this one developed by Metamark Genetics) may have value in the assessment of risk for biochemical progression after first-line surgery for prostate cancer.

According to an article by Saad et al. in the Journal of Urology (and as also reported on the MedPage Today web site), it appears that MetaMark has developed a new 12-protein biomarker-based test that can be used to analyze biopsy tissue and categorize patients into those who are at low, intermediate, and high risk for biochemical recurrence after first-line treatment.

For the 288 men to whose biopsy samples this test was applied, at an average (median) follow-up of 68.5 months post-treatment,

  • Biochemical relapse was evident in 47 (16.3 percent)
  • Metastases were identified in 5 (1.7 percent).
  • On univariate analysis, assay scores predicted biochemical relapse significantly better than other preoperative prognostic parameters (HR = 1.724, p = 0.0002 per 20 percent change in score),.
  • The assay score had a significantly higher p value when combined with clinical National Comprehensive Cancer Network stage compared to stage alone (HR = 1.579, p = 0.0017 per 20 percent change in score).

This new test appears to be an evolution of the ProMark™ test that we had first discussed back in 2014 (which was based on only eight protein biomarkers).

In an associated editorial in the Journal of Urology, Eric Klein of the Clevekand Clinic writes that this study:

adds to the growing body of evidence that clinically useful information about the aggressiveness of prostate cancer can be obtained from needle biopsies despite known issues with sampling error and genetic heterogeneity.

He continues by stating that

As such, we are on the threshold of being able to exploit biological information beyond that contained in the classic triad of grade, stage, and PSA to allow for a tailored management approach for newly diagnosed patients, including who to put on active surveillance, who is likely to respond to radiation or androgen deprivation, and the choice of specific drugs for individual patients.

3 Responses

  1. My concern for all post-first line therapy patients, including me in future, is to ask the following question.

    How do the results change the clinical management?

    Being told one is low-risk would be nice, and being told the opposite would be nasty, but what does one do differently? Why does this not fall into the “ignorance is bliss” category?

  2. Dear bgollum:

    You are asking a very complex question that has multiple possible answers depending on some or all of the following:

    Exactly what the results are
    — The individual patient’s attitude to risk vs. benefit for a whole range of possible next steps
    — What one’s original data were at diagnosis and post-treatment
    — What one’s life expectancy is if one was to “do nothing”
    — What form of first-line treatment one had
    — What sort of physician one is asking that question of (e.g., academic or community-based; surgeon or radiation oncologist or medical oncologist)

    The “ignorance is bliss” approach is certainly one of many possibilities, but knowledge allows one to make wiser decisions (so long as one understands that there are no certainties). For example, even if one just monitors any particular situation, there is still the question of “how carefully” (i.e., how aggressively) one wants to do that.

  3. Yes I suppose it might affect risk/reward considerations of adjuvant therapy. Thanks

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