Genomic testing for localized prostate cancer: an update

A relatively brief, current, full-text review article by Loeb and Ross is available on the Medscape web site and discusses the three currently available tests for assessment of genomic risk for men with localized forms of prostate cancer.

The article by Loeb and Ross is entitled “Genomic testing for localized prostate cancer: where do we go from here?” It is a straightforward and reasonably understandable summary of currently available data on the use of the Prolaris test (from  Myriad Genetics), the Oncotype Dx test (from Genomic Health), and the Decipher test (from Genome Dx). It was initially published in Current Opinion in Urology and is reprinted with permission on the Medscape web site.

However, the title is a little miseleading because it doesn’t actually address “where do we go from here?” What it does is address exactly where we are as of now.

Loeb and Allen summarize the key data for each of the three tests and what they can be used to do.

The fundamental utilities of the three different tests, as of today, are as follows:

  • The Prolaris test uses tissue from a biopsy sample to predict the risk of prostate cancer-specific death within 10 years for men being managed conservative or expectant management (i.e., watchful waiting and active surveillance).
  • The OncotypeDx prostate cancer test again uses tissue from a biopsy sample to project risk of adverse disease at radical prostatectomy.
  • The Decipher test uses tissue from a radical prostatectomy sample or (more recently) tissue from a biopsy sample to measure genome-wide RNA expression and allows for the development and refinement of prognostic signatures, for the development of predictive signatures for treatment response, and for the molecular characterization of tumor subtypes in a variety of different settings explained in the article.

This is a useful summary article that we recommend to prostate cancer support group leaders, patient mentors, and other prostate cancer educators to help them in their activities regarding the types of tests currently available for the work-up and prognosis of outcomes for patents at diagnosis and after first-line treatment.

Whether any one of these tests is actually “better” than the others in terms of their predictive accuracy at this time is not yet known.

6 Responses

  1. If one has already experienced metastasis after initial and additional treatments, does it make any sense to do any of these tests?

  2. Dear Bob:

    In my entirely personal opinion, probably not.

  3. Reading the somewhat gobbledygook (to the layman) description of the third test, the Decipher one, where it speaks of “the development of predictive signatures for treatment response” does lead one to think this third test might be of some benefit in selecting (or customizing?) some additional treatments that might exist beyond what has been tried for the metastasis.

  4. Dear J:

    Yes … and the key word is “might”!

  5. Can a person have a Gleason 3 + 3 = 6 and have a genomic test that says “Aggressive” from a biopsy sample?

    Thank you,


  6. Dear Mark

    Yes. That is perfectly possible. If it happened to me I would want to have the original biopsy slides re-examined by an expert uropathologist before deciding what I wanted to do. It is possible that a less than expert pathologist had mis-identified some Gleason tissue as Gleason pattern 3 when it was Gleason pattern 4.

    The other possibility is that the laboratory that ran your genomic test muddled up your tissue sample with someone else’s and you were given the wrong result as a consequence. It happens. Humans make mistakes, but this one would be unusual.

    Clearly you have received conflicting evidence, and the most critical issue is for you to have a detailed conversation with your doctor as to what he or she thinks you could do to resolve the conflicting information. One possibility would be to have an MRI scan and — if necessary — a targeted re-biopsy based on that MRI scan.

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