TMB low, Alterations : TMPRSS2-ERG fusion and AL1 K609del
Very low mutation, nothing doable for now from this point. Could it change with time, and if yes, should a new test be done later (must be biopsy or blood test possible?)?
TMPRSS2-ERG fusion: anything to do also in terms of supplements or avoiding foods?
The test was done from one sample, what I don't really understand, since it was not the highest Gleason sample. I mean, they could differ in mutations, no?
I agree with you. It was pointless to do a Foundation One test from a prostate biopsy sample. It's meant to be used on metastasis biopsies, not prostate biopsies. Guardant 360 cell-free DNA is expensive but provides a better picture of metastases. You are also correct in that it changes over time. Right now, there is little one can do with the info it provides. Maybe someday in the future it will be more actionable.
I was told that at the recent prostate cancer symposium it was recommended that all pc patients get a Foundation One or similar test.
Be careful about info you receive at a "symposium"-- they often present a dumbed-down version for patients, and add their own personal opinions (not that professional opinions are bad - it's just that it may be difficult to separate the facts from their opinions). A test is only worth getting if it can potentially change a treatment decision. I should mention too that Foundation One requires a lot of tissue, which may not be possible from many of a patient's metastases. An IHC analysis is often preferable (providing more actionable info) and less expensive. Guardant 360 is also a better source of info because it includes DNA from all mets, and not just the ones chosen for biopsy. There is great heterogeneity in the DNA of different metastases.
Symposium might be wrong word. It was the major national pc meeting. My MO is the one who told me they were recommending tests for all pc patients.
I believe my comments are true for any meeting designed for patients.
It was for MOs.
Are you saying ASCO made that recommendation? I didn't see a change in their guidelines to reflect that.
Don’t know ASCO...just repeating what my MO told me last week. I did sign up for Foundation One test and they will use preserved tissue from HoLEP procedure that led to cancer diagnosis.
As you can see from the OP's post, using prostate tissue for a Foundation One test is a waste. It tells you nothing useful beyond what a germline test could have told you. It may be useful (but probably not) for an IHC analysis instead. If your insurance will only pay for one test, at least do it on metastatic tissue. Maybe discuss these issues with your MO before you commit.
Yes, we heard that too from our MO. Here is a link to a free genetic study if you qualify. My husband's doctor recommended it even though he already has had genetic testing.
redcap.iths.org/surveys/?s=...
To clarify, we heard the same as Mkeman that prostate MOs are encouraging genetic testing per the link above. The order of the comments makes it confusing as I was responding to Mkeman.
That link is only for germline testing. The question at issue here is somatic testing.
The link was to provide to others on this forum with metastatic disease a way to get genetic testing so they can have more information about their cancer and options for treatment.
Great information. Can you also indicate whether you think the Decipher test done on prostate tissue is worthwhile. As you can see from the comments here there is a lot of lay confusion over which test is worthwhile and when. I may be wrong but I thought the Decipher test/ grid was intended to both reveal which future therapy might be best on recurrence and to provide certain aspects of the tumor that might suggest targeted therapies. Confusion also occurs because of the what you point out as ” heterogeneity “ which I assume you mean that once the primary tumor has mutated to metastasis that the characteristics of the distant tumors are different than the primary tumor and then the question is if one or more of the distant tumors are themselves distinct from both the primary tumor and each other which test captures all of that heterogeneity for an actionable plan.
Many Thanks
Decipher is a great test if you are sitting on the fence about whether to have salvage radiation after prostatectomy. It tells you the chances of metastases in 5 or 10 years. Their GRID report suggests whether SRT will be effective for you, although I think it requires further validation. It is done using prostate tissue (rather than metastatic tissue). Usually it is concordant with risk factors (like SVI, high Gleason score, etc.), but can sometimes add new info. It should be based on tissue from multiple cancer sites within the prostate.
Prolaris, Oncotype Dx, and Decipher can be run on biopsy tissue and may be useful if one is sitting on the fence about active surveillance. Confirm Dx is a DNA methylation test on non-cancerous tissue that can be used to confirm a negative biopsy when there is suspicion that the biopsy missed something.
One of the hallmarks of cancer is genetic breakdown. The DNA loses the controls that maintains its integrity, and it mutates more freely with time. This will always occur. For this reason, a metastasis that occurs earlier may be less genomically broken than a met that occurs later. Complicating this is the source of the metastatic clones (it may start out more genomically broken if it arises from, say, a G5 than a G4, or from an early met vs a prostate source. There is great genomic heterogeneity among metastases. So if you just sample a single met (using Foundation One or Claris), you are just getting a snapshot in time and place. It also means that a medicine like carboplatin or a PARP inhibitor will only be effective on those mets (or some cancer cells within older mets - cancer cells are even heterogeneous within a single tumor) in which significant genetic breakdown has occurred. If the earlier snapshot doesn't reveal any actionable mutations, there may be actionable mutations later. Cancer is a moving target.
It is different when the genomic mutations are part of all cells (germline). Color Genomics Dx offers an expensive test ($200) for this:
pcnrv.blogspot.com/2018/02/...
Guardant 360 takes a different approach. It looks at cell-free DNA - bits of cancer DNA that circulate in the blood after cancer cells have been cast off from metastases and lost cellular integrity. It is still a snapshot in time, but the DNA can have come from any place. It includes both germline and somatic (tumor) mutations. It is sort of a weighted average of all the mutations in the body at that time.
How much did the Foundation One test cost you ?? Or your insurance company ??
Payed by insurance. It was ordered by the hospital.
Thank you, Myriammole. I had to incur a cost of close to US$ 4200/- to get it done here in Bombay.
Uau!!!! Expensive!!! Did they find something useful for you?
It appears they found some very useful things. I am in talks with my doctors to understand what to do next.
My main MO, a female, who worked at Johns Hopkins and Dana Faber, before returning to India, is also seeking the advice of her colleagues in the US.
I will probably have a comprehensive picture before me in 30 days or thereabouts. In the interim, I am going through the Lu-177 therapy. Second infusion scheduled for 25th June, 2019.
Thank you and all the very best to you.
Let me know what they found.
Update after 3rd Lu177
Need ideas post Xtandi and Zytiga
1 Year after taking Zytiga (Abiraterone) PSA from 750 to 54 
Foundation One partial report
looking for treatment advice 
