Onco-DX Result

I requested and obtained a genomic test from Onco-DX on my biopsy sample. Being in the NCCN "very low risk category," I figured this might be a good data point in the decision to pursue AS or not.

Admittedly, I had low hopes for getting anything useful out of this. However, I was pleasantly surprised to see that I am in the most favorable tail of the risk distribution. The GPS score was 5 (from 0 to 100), and the Likelihood of Favorable Pathology (LFP) was 94%. (LFP is defined as the disease is both low grade and organ confined.)

My urologist did advise that this test would be valuable in the AS decision if there was a strong signal one way or the other. So based on these results, I am putting more weight in this test than I initially had. Of course, I still have an MRI scheduled in one month which will really drive the subsequent steps in the process.

Thanks for listening, and if anyone has comments on this genomic test one way or the other I would be glad to hear them!

Great news, Paul, I had that test in 2013 when Johns Hopkins was doing a quality review just before its release. My GPS score was 2. But, my favorable pathology was 86. It's interesting how the numbers can change around, I guess due to what the gene assay is.

Anyway, most GPS scores that I have read in PCa forums are much higher than single-digits, even for guys in AS. So you and I are lucky to be in that very low risk group.

Of course, keeping up with all your testing while on AS is most important.

Paul, I had to go pull up that report on MYChart just now. You are correct, in that "favorable pathology" was on the report. I think that the "remaining indolent" was a from a question I posed to my specialist, who is a Professor of Uro-oncology, who was involved with approving that test.

Taking some liberty with language, I don't see much different between "favorable pathology" and "remaining indolent". That has certainly been my experience over the past eight years.

Please Keep in mind that the purpose of the OncotypeDX test is predictive based on how the genes match up with known outcomes, and is more than a snapshot at this moment in time.

How much did it cost you?

Paul, Yes, you are correct. The genomics tests only assay the positive slide specimens.

Once you are part of a formal AS program, you are subject to their regimen of this test on that schedule. And, they can change the rules and the tests as their latest results are analyzed.

But, trust me, its a good place to be.

If someone is poor like me, the cost, around $4,000, is a big issue. For most guys, especially those at very low risk, like yourself, it will almost never make a difference in the AS decision. And in those few where it would make a difference, it would be caught on the confirmatory mpMRI-targeted biopsy anyway.

The real value is for men who are low risk, but not very low risk, who may have a lot of positive cores, a high % of cancer in the cores, bilateral invasion, top and bottom invasion, small prostates, or high PSAs. In fact, I would have been a good candidate for it.

My test was offered at no cost under a clinical trial.

According to this article, the cost is $3,820. You may have much better insurance than mine. My deductible is $1,000, after which my insurance picks up 70% of the cost - but that's if the test is approved. Mine won't approve Oncotype Dx or Prolaris.

It may or may not pick that up. Recent data is showing that the tumors within the prostate can be genetically diverse, so depending where the core came from, it may not pick up a higher score. The best way to detect a high grade tumor is with an mpMRI-targeted biopsy or a template-mapping biopsy. The cost is about the same, probably covered by insurance, and is more certain.