October 30, 2013.
Dennis R. Hill M.D. Radiation Oncologist at the Alta Bates Summit Medical Center in Oakland, CA reports that there is considerable interest in genetic testing for prostate cancer. He notes that at the June meeting of the American Association of Clinical Oncology a presentation about one of the relatively new tests suggested that it could predict which cancers would be aggressive and which would be indolent. If it could be accurately determined, aggressive tumors would need active treatment such as surgery, external beam radiation, permanent seed implant, or High Dose Rate brachytherapy. Indolent disease could be put under active surveillance and treated only if it progressed. The Prolaris test*, which measures the activity of cell cycle progression (CCP) genes in prostate cancer biopsy samples, was evaluated for its ability to predict either death from prostate cancer or biochemical recurrence in five published studies. All five studies were company sponsored. The presenting physician, concluded that “the CCP score predicts prostate cancer outcome in multiple cohorts and diverse clinical settings. It provides independent information beyond classic clinical pathologic variables and can help differentiate aggressive from indolent cancers.”
Dr. Hill says that there is considerable interest in genetic testing in prostate cancer because there has been success in breast cancer. Genetic breast cancer tests can be predictive of a patient’s response to breast cancer therapy but there is not an equivalent advantage with prostate cancer. “You are either at higher risk or lower risk. There are no firm cutoffs that would steer decisions toward a different treatment in prostate cancer,” he said. “If we have a new biomarker, we need to be able to demonstrate the ability to affect clinical management or treatment decisions.” However, Dr. Hill pointed out that, for the majority of patients that have had the test in his practice it did not change the risk category that was predicted by the standard parameters of PSA, gleason score, clinical stage, biopsy cores positive and perineural invasion.
Dr. Hill says that the test, which is expensive at about $3,400 and not covered by Medicare or most insurance companies does not help medical decision making beyond the standard National Comprehensive Cancer Network (NCCN) risk categories predicted by stage, gleason score and PSA. “It is not money well spent at this point in time,” says Dr. Hill.
*2013 Annual Meeting of the American Society of Clinical Oncology. Abstract 5005. Presented June 2, 2013.
About Dennis R. Hill MD
Dr. Hill is a board certified radiation oncologist doing High Dose Rate brachytherapy exclusively since 2004 and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD, 3012 Summit Street, Suite 2675, Oakland, CA 94609 510-869-8875. His email is firstname.lastname@example.org and his website is hdrprostatebrachytherapy.com