Oncotype DX Prostate Cancer Test

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robertC
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   Posted 5/8/2013 8:21 AM (GMT -6)   

LupronJim
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Date Joined Apr 2013
Total Posts : 1146
   Posted 5/8/2013 6:23 PM (GMT -6)   
Thanks.

A couple more links I added to similar post on Inspire forum

http://www.genomichealth.com/Company/Perspectives.aspx#.UYqjOrXvuSp has a video

http://www.myprostatecancertreatment.org/en-US/about-Oncotype-DX/Oncotype-DX-for-Prostate-Cancer.aspx#.UYredbXvuSp
Diagnosed @ age 64 Feb 2013 PSA 3.68 (6 mo velocity) Gleason 9 (4+5)

T1CN0M1B a/k/a D2 Adenocarcinoma w. 7 of 12 cores worst ones 70% right perineural Invasion PNI

Oligometasteses 5 tumors 1 right sacrliliac, 2 thoracic vertebral bodies (spine), 2 right posterior ribs

Began Lupron 4 month 03-28-2013.
PSA after 28 days 0.90 w free PSA 0.22, T=24

In UF & Shands Metastatic Disease Program

Jim

Aachen
Regular Member


Date Joined Dec 2012
Total Posts : 112
   Posted 5/9/2013 6:51 AM (GMT -6)   
Why aren't urologists or oncologists mentioning this or the Polaris test, put out last year?

I've specifically asked each one I've met with if there is anything new in terms of treatment or staging or testing and to a man they've all said no.

When I went for consult at Johns Hopkins they asked if I'd like to be involved in a genome test. They said they were working on a genetic test for aggressiveness of cancer. But they also said their test results would be ten years away at best.

They failed to mention that two other companies already had these tests.

Am I reading too much into this?
47 yrs old.
Diagnosed Dec 1 2012. PSA 5.34 pre surgery (PSA was 3.99 two years earlier).
Robotic prostatectomy March 6 2013. All clear except one 1.2cm positive margin in posterior, with some bladder neck
Gleason 3 +3 overall (with tertiary 4 in some spots) as read by Johns Hopkins (though another hospital said Gleason 7 (3+4) 4 mostly tertiary. pt2x.
PSA .02 April 2013

akai
Regular Member


Date Joined May 2012
Total Posts : 166
   Posted 5/9/2013 9:05 AM (GMT -6)   
Good question.

While my Uro recommended AS for me after Dx,he never mentioned PCA3 when I first met with him, I had to ask for it. When I asked him about a recent FDA approved test (PHI), he said he was not aware?

Prolaris costs about $3,400. Oncotype Dx costs $3,820. I believe neither is covered by insurance at this time.
Age 59 as of 2013
PSA 2003=1.5, 2005=1.3, 2007=1.9, 2008=1.8, 2010=2.3, March 2012=3.1, May 2012=3.35, May 2012=3.6, several differnt Labs and Assays
Bx and Dx Aug 2012 = 3 of 14 cores all G6 (USC and City of Hope Path), Follow AS,
After Dx with PCa
Three months - PSA Oct 2012=2.5, Nov 2012=3.16, Nov 2012 2.1, three different Labs/Assays
Six months - PSA Feb 7, 2013=3.29 (up from 3.16)

Aachen
Regular Member


Date Joined Dec 2012
Total Posts : 112
   Posted 5/9/2013 10:13 AM (GMT -6)   
I'm sorry. What is PCA3 and what is PHI?
47 yrs old.
Diagnosed Dec 1 2012. PSA 5.34 pre surgery (PSA was 3.99 two years earlier).
Robotic prostatectomy March 6 2013. All clear except one 1.2cm positive margin in posterior, with some bladder neck
Gleason 3 +3 overall (with tertiary 4 in some spots) as read by Johns Hopkins (though another hospital said Gleason 7 (3+4) 4 mostly tertiary. pt2x.
PSA .02 April 2013

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 1673
   Posted 5/9/2013 10:50 AM (GMT -6)   
Genomics also does the Oncotype for breast cancer. My wife had it run two years ago and it was covered by insurance. It cost about $3k. I am not aware of these PCa tests yet being covered by insurance. Further, I don't know if they are covered by Medicare. That is usually the key. Insurance companies most often follow the lead from Medicare.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 and Testosterone less than 3 since February 2011

Aachen
Regular Member


Date Joined Dec 2012
Total Posts : 112
   Posted 5/9/2013 10:52 AM (GMT -6)   
JNF:

Thanks. Yep, it looks like the test has a good history in use for other cancer.

Anybody have any thoughts on it's usefulness for prostate?

It's weird to me that not a single one of my urologists or oncologists even mentioned it in passing, when clearly I was asking questions about treatment and staging.
47 yrs old.
Diagnosed Dec 1 2012. PSA 5.34 pre surgery (PSA was 3.99 two years earlier).
Robotic prostatectomy March 6 2013. All clear except one 1.2cm positive margin in posterior, with some bladder neck
Gleason 3 +3 overall (with tertiary 4 in some spots) as read by Johns Hopkins (though another hospital said Gleason 7 (3+4) 4 mostly tertiary. pt2x.
PSA .02 April 2013

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3706
   Posted 5/9/2013 11:23 AM (GMT -6)   
Aachen,
Unfortunately most doctors are uneducated in advanced prostate cancer testing and diagnostics. I spent ten years trying to find the cause of my high and rising psa and went to 5 urologists/oncologists at 4 major centers. Only one knew about MRIS, none recommended color doppler ultrasound which eventually discovered my cancer and none knew about Combidex. Not one used the various psa kinetics and variants like PSADT, PSA density and PSA velocity as a diagnostic tool. Not one used nomograms or the various tables available. No one offered me a PCA3. It was only after I went to a medical oncologist specializing in PC that i discovered all of these diagnostic tools. He used all of them to come up with a diagnosis and recommendation that was totally accurate. Unless a doctor specializes in PC and that's the only thing he does, don't expect a lot of knowledge on the subject or a complete DX of your condition.
JohnT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 3 years of psa's all at 0.1.

Aachen
Regular Member


Date Joined Dec 2012
Total Posts : 112
   Posted 5/9/2013 11:26 AM (GMT -6)   
John:

Can you explain exactly what a medical oncologist does, as opposed to a radiation oncologist?
47 yrs old.
Diagnosed Dec 1 2012. PSA 5.34 pre surgery (PSA was 3.99 two years earlier).
Robotic prostatectomy March 6 2013. All clear except one 1.2cm positive margin in posterior, with some bladder neck
Gleason 3 +3 overall (with tertiary 4 in some spots) as read by Johns Hopkins (though another hospital said Gleason 7 (3+4) 4 mostly tertiary. pt2x.
PSA .02 April 2013

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 1673
   Posted 5/9/2013 1:48 PM (GMT -6)   
Medical oncologist uses drugs and chemo therapy to treat cancer. Rad onc uses radiation. While some rad oncs might prescrive HT they will generally not do infusions of chemo like taxotere.

Regardsing these two new tests, I think it will be a while before strong utilization will be used. Many men are just clearly very low risk and no one is going to spring for several thousand to confirm that the G6, PSA of 4, 1 of 12 cores positive for 5%, is actually what the biopsy says. At the other end my statistics indicated clearly that I am high risk. There will be those in the middle that need better confirmation that can benefit. It will be interesting to see what triggers will be used in terms of PSA and biopsy results to use one of these tests.

In the case of breast cancer, not all women have the Oncotype Dx performed. It is reserved for those that may be facing chemo, but are not at a significantly high risk that would clearly dictate chemo. My wife had a suspected micromet in a lymph node and the surgeon was also unable to get a large enough clear margin at one spot of the tumor. The med onc ran the test and the results indicated that she faced a 24% probability of recurrance within seven years without chemo. It then showed the probabilities of recurrnce having chemo in several different drug combinations and dose levels. The med onc used the test results to fine tune the chemo plan to maximize treatment effectiveness and minimize damage from the chemo.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 and Testosterone less than 3 since February 2011

colorado monkey
Regular Member


Date Joined Mar 2013
Total Posts : 39
   Posted 5/9/2013 2:55 PM (GMT -6)   
So how similar is this to the Prolaris test?

I had one of these tests run at the University of Colorado Hospital. Mine came back as -0.4, or in the 37 percentile. Interpretation: For AUA low risk, 37% of the patients in the AUA low risk category had a lower Prolaris score. 10 year prostate cancer specific mortality rate at 1% with a 95% confidence interval. Interpretation: The patient has a 10 year mortality risk of 1% if managed conservatively. Mortality risks could be altered by various therapeutic interventions.

Good information to have I guess, at a pretty pricey cost.... $3400

Just curious as to the difference.
Dx at 44 with T1c. In good health and good shape.
1st PSA 6.36 12/2012
2nd PSA 5.3 20.2% free PSA 1/2013
PCA3 45 2/2013
Biopsy 2/27/2013
Gleason 3+3=6 4of 12 cores positive left apex 20%, right apex 40%, left base lat 5%, left apex lat 20%
MRI 3/22/13 No evidence of extracapsular extension or involvement of local or regional nodes
4/22/13 Bone scan No evidence of osseous metastasis

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3706
   Posted 5/9/2013 3:13 PM (GMT -6)   
Aachen,
To add to what JNF said, I have found that medical oncologists specializing in PC approach the disease from a biological perspective; that means they first look at the biology of the cancer, it's growth rate and its aggressiveness and make treatment recommendations based on that. Both radiologists and urologists approach the disease from a mechanical perspective and use mechanical means to address the cancer.
There are only about 100 medical oncologists specializing in prostate cancer in the US so they are a rare breed and you have to search to find them. In the appendix of "Invasion of the Prostate Snatchers" by Dr Mark Scholz, a medical oncologist specializing in PC there is a list of all the prostate oncologists in the US and their contact information.
If you read books by Dr Scholz, Dr Myers and DR Strum all medical oncologists and then read books by Drs Walsh and Scardino, urological surgeons specializing in PC or Dr Dattoli, a radiation oncologist you can see the significant differences in how each speciality approaches this disease.
It is also unique in prostate cancer that urologists, surgeons by trade, diagnose recommend and treat PC. In all other cancers a medical oncologist does the DX and treatment recommendations and uses surgeons or radiologists as part of the treatment team with the medical oncologist being the team leader and calling the shots.
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 3 years of psa's all at 0.1.

Aachen
Regular Member


Date Joined Dec 2012
Total Posts : 112
   Posted 5/10/2013 7:53 AM (GMT -6)   
John, as always your posts are very helpful.

Thank you.
47 yrs old.
Diagnosed Dec 1 2012. PSA 5.34 pre surgery (PSA was 3.99 two years earlier).
Robotic prostatectomy March 6 2013. All clear except one 1.2cm positive margin in posterior, with some bladder neck
Gleason 3 +3 overall (with tertiary 4 in some spots) as read by Johns Hopkins (though another hospital said Gleason 7 (3+4) 4 mostly tertiary. pt2x.
PSA .02 April 2013
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