LIQUID BIOPSY

[Christopherg]

when is the time to do a liquid biopsy

Which company is the most experienced and gives service

I appreciate your advise

Sincere thanks

Chris

[Tall_Allen]

After you have visible metastases.

[Christopherg in reply to Tall_Allen]

I do showing by PSMA but not ct

It’s lymph nodes only

Should I still do the liquid biopsy?

Thank you so much Tall Allen

[Seasid in reply to Christopherg]

After your PSA is above 5 or even better above 10.

[Tall_Allen in reply to Christopherg]

No.

[Derf4223]

I recently asked my MO about getting a serial liquid biopsy. Here's her answer

"Circulating Tumor DNA (CT-DNA) testing is where the blood is analyzed for free-floating tumor DNA. This is being used in breast, colon, lung, and sometimes bladder cancers, but colon cancer is really the domain for it right now. Guardant only looks at Breast, Colon, and Lung, not Prostate. Signatera is the one I use the most, but it also does not cover Prostate (link below). Why does it not cover prostate cancer?? Because the PSA is the absolute best tumor we have in all of oncology! Also, we don’t know what to do if we detect a recurrence really early. Prostate cancer is a slow cancer (usually), and treating the heck out of it too early may leave a patient with a lot of side effects and a quiver of spent arrows. I recommend PSAs. Things will change over time, but not yet. I also inquired of Dr. Richard Lee at MGH who agrees that PSA is king and that there is no role for testing of CT DNA in prostate cancer at this time. He is a member of the NCCN for Prostate cancer and helps write our country’s guidelines for the care of Prostate Cancer.

natera.com/oncology/signate...

[NanoMRI]

Interesting replies - especially since my second, done back in July, identified TP53 R248Q somatic alteration, done at uPSA 0.033, using GUARDANT360 test. This maker (last years GUARDANT360 was clear) and concurrent PSMA PET finding of a liver lesion (prior two were clear) are getting lots of attention right now.

From my perspective, still being a young and active 67 (diagnosed at 57), early investigations and early actions are key. My chosen medical team and I strive to stay ahead of this beast and not give it time and obscurity.

FoundationOne Liquid CDx is another of these newer tests but my docs do not (yet) use it. There is lots to read about these including application with prostate cancer. I am finding very few docs are using these, and of course, there are the "guidelines" and money issues. Note, Medicare has paid for both of mine and when we hear of guidelines I like to raise the question - how did the screening guidelines benefit all of us?

Side-note: back in 2015, at the time of my investigations post diagnosis, I learned of Genomic testing during consultations in England. My docs back home in Texas were aware but did not use them because insurance did not cover for prostate cancer. I still have my appeal denial letter from BCBS Texas citing the test as experimental and unproven and that they they did not anticipate approval. How wrong, as two years later in October 2017, Medicare granted approvals for prostate cancer testing.

I hope my perspective helps - all the best!

[Mgtd in reply to NanoMRI]

I doing some research on liquid biopsy and came across your input.

After radiation 15 months ago I have been experiencing rising PSA in of 0.01 to 0.02. My MO told me I am probably experiencing recurring PC after radiation.

To day she surprised me when she said none of the traditional tests would be of any value at this low a PSA. Of course I knew that and let her finish.

She said she does not get to see someone of my level of recurrence with as low a PSA history and she wanted to see if a liquid biopsy could add anything to the picture at this point. She is going to do the FoundationOne test in January prior to my next appointment.

Based on your comments the use of that test maybe at least in new MOs maybe starting to get some traction.

Thought you might enjoy this tidbit. Think she is being proactive and perhaps thinking outside of the SOC box.

[NanoMRI in reply to Mgtd]

Yes, appreciated SOC is such a conundrum of contradiction. It is certainly not linear - it is a very broad spectrum of care from inadequate (not screening all men for PC) to over-the-top. IMO liquid blood biopsies are within SOC as they are readily available from multiple suppliers and insurance covers them - Medicare paid for my two. Sadly they seem very uncommon - perhaps because they do not yet fall into most doc's spectrum of (easy) thru-put, coding and (profitable enough) billing. Perhaps because these are far more effort than a simple blood test and many docs are not trained on them.

[Mgtd in reply to NanoMRI]

This oncology practice at least in my experience is different. They have a in-house blood draw. So it is kind of a one stop shop.

It makes it convenient for the patient. Not sure if they do their routine testing in house or not. With the liquid biopsy they have to send it off site.

[NanoMRI in reply to Mgtd]

Similar. This is the process I have seen, twice, and sees to me understandable work efforts many docs do not want to take on. I had to sign several documents, including financial responsibility should their claim to insurance be declined, then in-house blood draw, then they had to package it up and mail it out. Then results came back differently than routine blood work, hard copy and these have to be manually entered and handed to me. Also, they have a cabinet of shipping boxes containing the draw tube. My first one was NED - important for me in staying out ahead of PC as part of my trifecta of testing - uPSA, blood biopsy and imaging. As I share, my second one, this past July, identified the TP53 mutation which we presumed was PC but has turned out to be metastatic melanoma. Had I not done my PC trifecta testing my metastatic liver melanoma met would have gone unnoticed until symptoms. Because of this singular met finding I may just have a chance.