Newly diagnosed - is genomic test beneficial

Hi DJL21. Please create a signature file with your salient information to date: your age, any prostate cancer in family?, PSA history, the number and grade of positive biopsy cores and percent cancer in each, any history of BPH?, any imaging results, etc. That way Forum brothers don't have to hunt through your other threads to get the details that will focus their answers and suggestions. As you add new information, your signature will become a helpful reminder for you, too, and will save you al lot of typing as well. Your signature will appear at the bottom of all your posts.

Before considering a genomic test, I would ask your uro to send all your biopsy slides directly to Dr. J. Epstein at Johns Hopkins for an expert review. A second opinion is especially helpful for newly diagnosed G6 men. You want to know as best one can what you are dealing with. Dr. Epstein sometimes up/downgrades lesions or finds lesions on slides first judged to have none. Since the decisions about AS vs. treatment and type of treatment are based primarily on one's biopsy, you want to have the most accurate, reliable information to make those decisions.

After a second opinion, if you are still a candidate for AS based on your biopsy, a genomics test (e.g. Decipher Biopsy, OncotypeDx, Prolaris) may help you by providing: (1) your risk (low, average, or high) of progressing to higher-grade lesions that metastasize within 5 years) and (2) your risk of now having adverse pathology (growth of cancer out of the capsule and/or into neighboring structures). Imaging can help with (2); however, this growth may be microscopic, and therefore not seen unless the whole prostate is examined (if surgery is the chosen treatment).

You would never be forced into AS. Some men who are candidates, but not ideal candidates, for AS choose treatment instead. Biopsies and scans can miss high-grade lesions and not all men are psychologically suited to AS, although AS, if followed according to protocol, has a good track record of letting men know if and when it's time to treat.

I disagree with your uro. IMO a genomics test is a good idea for G6 men (confirmed by a second path opinion) who are interested in going on AS. You want to rule out being the roughly one in ten G6 men who are at high genomic risk for progression and mets within 5 years.

In a nutshell: a second biopsy opinion from an expert in prostate pathology is, IMO, the best thing you can do for yourself at this stage. It's usually covered by insurance and, if not, is not expensive. After that, a genomics test may help if the AS/treatment decision remains on the table and AS interests you.

Djin

DJL21 said...
I included all data in signature block. Not sure why it is not showing up.
I asked for second opinion from Johns Hopkins. I think my urologist is going to tell me how to get slides to them.
I could only find one study on Oncotype DX that concluded a higher GPS was associated with an increased risk of biopsy up-grading. My insurance covers test but says "considers repeat testing or use of more than one type of test to assess risk of prostate progression (Oncotype...) experimental and investigational".

55 yo, DX 5/10/22, T1c, 2/12 cores < 1mm < 5% and 1 high grade pin, G6, PSA 3.66, free to total ratio = 21%, 50.4 cc psa density 0.07
5/4/22 TRUS biopsy 2/12 left apex and right base, high grade pin right mid
5/21 transperineal biopsy - lesion negative, atypical other side
12/20 MRI Pirad-3 lesion

there's always a delay, even if you modify your profile