New prostate cancer test improve risk assessment

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A new tool helps identify men who are best suited for active surveillance of prostate cancer. This new genomic test can help predict which men are more likely to harbor an aggressive form of the disease.

The test, which improves risk assessment when patients are first diagnosed, can also aid in determining which men are suitable for active surveillance, which manages the disease without direct treatment. A study evaluating the genomic test was presented with its results at the American Urological Association's annual meeting in San Diego, California, on May 8.

Prostate cancer often grows slowly, and many of the quarter-million patients diagnosed annually in the United States never need treatment. Still, most patients with low-risk prostate cancer in this country immediately undergo treatment.

The new test, studied by the University of California at San Francisco, provides “statistically significant and clinically meaningful” prognostic information. It can help identify many more low-risk men who could safely choose surveillance, sparing them unnecessary treatment and avoidable negative side effects. At the same time, the test can pinpoint men at apparent low-risk who in fact may have potentially aggressive tumors.

"With the new test, we can more confidently recommend active surveillance when it is appropriate,'' said the study's lead author, Matthew R. Cooperberg, MD, MPH, of UCSF. “And through active surveillance, patients can avoid or delay surgery or radiation for their condition.

"Active surveillance is increasingly acknowledged as a preferred strategy for most men with low-risk disease, but in practice it is used relatively infrequently," he noted. "There are many reasons why – financial, legal, and cultural among others. Many men don't want to live with anxiety over the chances of their disease progressing. So we need to predict with better accuracy which tumors harbor metastatic potential. If we are able to risk-stratify men more consistently and identify a greater proportion for active surveillance, we should be able to ameliorate overtreatment rates, and by extension help resolve the ongoing debate about PSA screening."

Investigators evaluated how well a 17-gene assay of prostate needle biopsy specimens could predict pathologic stage and grade at prostatectomy. The researchers focused on whether the test's biomarkers added independent, predictive information beyond what could already be determined through standard PSA, Gleason grade, and biopsy detail variables.

The men in the study ranged from 38 to 77 years of age at the time they were diagnosed, with a median age of 58. The patients' tumors had low or intermediate clinical risk characteristics.

The test was found to contribute prognostic information that was statistically significant and clinically meaningful. Its information was found to go above and beyond existing, previously well-validated instruments to characterize clinical risk. The test became available to physicians and patients after the data was presented.
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