Prolaris

I'd be interested in the experience others have had with Prolaris genetic testing. This has apparently now been approved for Medicare coverage (though not necessarily for full coverage by my Medicare HMO, it seems).

Are this test's results being factored into the various risk assessment tools (nomograms, etc.) yet? Are practitioners beginning to recommend it and then are they using it in the advice the offer their patients?

Thanks!

Would be int'd in hearing about others experiences also. This could provide some backup or peace of mind if you're are considering going the Active Surveillance route. I had a relatively favorable score but still didn't feel comfortable not treating given my GL score and family history.

I had the competitive product, OncotypeDX, analyze my biopsy slides. Since I am part of a research study group, I did not have to pay for it. When it returned a GPS score of 2, signifying a very low chance of aggressive cancer, I asked my specialist if I could skip future biopsies. He said no; that they only used the test to disqualify men with high scores. So, it's only a part of total data they look at.

There's some questions you may find useful in the sticky.

You should ask each specialist you talk to about the MRI they want for their treatment. There are different kinds of MRI and each treatment (and active surveillance) may require a different kind and at different points in time. Your insurance may balk if you make multiple requests for diagnostic imaging.

- Allen

Whip,
Number and % of cores involved have certainly been looked at in many studies, and some risk stratification schemes do incorporate them (e.g., CAPRA), but based on the most generally accepted one, D'Amico/NCCN, those risk factors pale in comparison to the more important determinants of risk - PSA, stage, and Gleason score. You may be interested in the following study from Johns Hopkins, which concludes "A low Gleason score on biopsy is a powerful prognostic finding, such that this favourable outcome is maintained even in the setting of multiple positive cores with GS6."

Multiple cores of Gleason score 6 correlate with favourable findings at radical prostatectomy

Of course, your diagnosis is riskier than a diagnosis with fewer positive cores or a larger prostate, but the increase in risk isn't enough to land you in the higher risk category.

When you say "apparently stage T2c" I'm assuming you are saying that based on the DRE that felt nodules on both sides (stage is not based on biopsy). That, together with >50% core involvement, puts you at unfavorable intermediate risk and takes active surveillance off the table.

When you talk to a surgeon, he will probably want an MRI (sometimes called a restaging MRI) to assure there is no EPE before he will operate on you. However, because of your small prostate and compromised urethra, he may (or may not) tell you it's not a good option anyway.

When you talk to radiation oncologists, they will probably want a combined MRI/CT done close to treatment time for planning purposes. Because radiation is highly conformal and treats an area outside of the prostate, they really only care that the radiation is shaped to the prostate plus any protrusions.

Since AS is off the table, there is no point in an mpMRI-targeted biopsy -- you already know you need radical treatment. That also obviates any need for Prolaris - no matter what it says, you need radical treatment.

What I'm suggesting is that you get the recommendation of the specialists for the specific kinds of MRIs they want to see before you go off and do it on your own.

- Allen