Genotyping?

The article focuses on circulating tumor cells (CTCs). CellSearch or AdnaTest are tests that count the number of CTCs and use that as a marker prognostic of metastatic progression. Trials are in the works. Other kinds of genetic tests like Decipher, Oncotype Dx or Prolaris look for certain genes, RNA or the proteins they code for. Again, the goal is to provide a measure of risk of progression. These are mainly of interest to men on Active Surveillance, or in clinical trials of substances designed to slow metastatic progression. The genetic anomaly they mention in the article, TMPRSS2:ERG fusion, is a marker associated with prostate cancer and high grade PC, so it is useful in determining when a biopsy is necessary.

Those are probably of limited interest for your father. Perhaps more interesting, there are certain genetic anomalies that dictate whether a certain therapy may work or not. The latest such discovery for PC was a genetic marker called AR-V7. It codes for a variant of the androgen receptor that is not vulnerable to Xtandi or Zytiga. Other genetic components may keep the immune system from attacking cancers. Others genetic anomalies keep the cancer cells from self-destructing, or keep growth factors turned on when they shouldn't be. This is all very new and investigational, which is probably why your MO hasn't brought it up.

- Allen

SpecialLady told me about Dr. Bonkhoff in Germany who does tests to see which receptors are active. So, for example, if a biopsy sample showed that the somatostatin receptors are active, then treatment with a somatostatin analogue like Octreotide or Lanreotide might be effective. If you send me an email, I can forward to you what she sent. There may be labs in the US that do this too - maybe your oncologist would know of one.

- Allen