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Genomic Test & Interpretation of Results / Treatment?

Anyone had experience with the Genomic test and the role that it plays in decision making regarding treatment?

I have yet to get my results, but was wondering if anyone has had the test, and how meaningful the results are in terms of decision making re: treatment v active surveillance.

Any thoughts would be greatly appreciated.

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Good morning Abraxis49,

Thank you so much for this question.

Where did you do your test?

Was it the germline or somatic?

Thank you and all good health. Mike

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Mike,

Thanks for reaching out. The test was submitted by my urologist. From what I understand a portion of the tissue from my mri guided biopsy was submitted for the test. I have included a link below to the website that explains the test. The test is called Oncotype DX. They have one that is specifically for prostate tissue analysis, and you can see on the website, the links to sample reports. Apparently it yields a GPS score that is helpful in deciding whether to treat or active surveillance, as well as aggressiveness and probability of a biological recurrence after treatment. Very useful if it's accurate.

My first question was whether or not it is covered under Medicare because I assumed it was expensive. As it turns out it is expensive = $4000.00. Having said that, if one meets the narrow criteria (you can find this on their website as well), is is covered; apparently all but $100. I couldn't pass that up.

I'm told I will have the results back next week.

oncotypeiq.com/en-US/prosta...

All the best.

Steve

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Thank you so much Steve.

Looks to me like you have an excellent oncologist.

All best wishes and good health to you. Mike

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Those tests can change your decision if you are on the fence about AS or treatment. Most of the time, they tell you what you already know. But once in a while, a low risk man will get a high risk score, which suggests that treatment may be a better course.

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What is the landscape like now for assessing germline mutations and their implication for risk?

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Color Genomics only costs $200. You mail them your saliva. It tests for some of the more common germline mutations.

pcnrv.blogspot.com/2018/02/...

Of course the OP is looking at somatic mutations based on prostate biopsy. For men with mets, there are other alternatives. The latest is cell-free DNA, which doesn't differentiate between somatic or germline, but doesn't require biopsy of mets.

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Thanks. I'll have to look into this "cell-free DNA". I don't know if MOs or surgeons are looking at these to guide how aggressively to treat. Just one piece of the puzzle, I know.

To your knowledge, are there any "targeted therapies" analogous to those for EGFR or ALK derangements in non-small cell lung cancer?

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It isn't really a question of how aggressively, it's more a matter of tailoring the treatment to the patient. It wouldn't be surgeons, but MOs, certainly. All we have so far are the ones in that article - more in clinical trials.

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Thanks!

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Thank you Allen!

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I had TWO genomics tests, Oncoptype and Decipher and got TWO different (expensive) results. The companies give you one or two sheets of paper, without further explanation. I’ve had a couple of docs dismiss the test results, or, discount them. None offered further commentary on the discrepancy.

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Thank you for reaching out and sharing your experience. So, what form of treatment did you chose? I know in time it seems one or the other test perhaps would be evident...all hindsight. What a crazy journey all this is.

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I’ve been on active surveillance for two and a half yrs. Single core 3+4, 40%, no lesion visible on MRI. Going back and forth on focal or whole gland, or, staying on AS.

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Thank you

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I had a decipher after my RP. I decided to have ART anyway. I only have 1 post that I created that has all my info including the results.

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Thank you

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I had the Decipher test. I used it as an additional factor in the treatment decision. The test indicated an aggressive cancer which, along with biopsy and mpMRI, indicated I should undergo treatment sooner rather than later. At the same time, the test represents statistics and a correlation so I used it strictly as another piece of data.

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Thank you!

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I had Oncotype Dx preformed on biopsy specimen. The result was 87% - meaning highly likely of low risk cancer. At the time, it supported the AS decision (biopsy was 3+3, PSA <10, 2 cores involved with < 10% positive). BUT, and here's the big BUT, you have to know how reliable the results are over time. I recall the disclaimer from the company saying the results were valid for up to 2 yrs. So, be cautious in your interpretation. And, as we know, traditional biopsies merely sample the gland and may miss cancer lurking nearby (for this reason, have you considered MRI fusion guided biopsy? It allows the doc to target suspicious areas). Also, Prostate Health Index is worth a look.

So, AS at Hopkins for 7 yrs. Numbers took turn for the worse. Radiation (IMRT and brachyboost) and ADT (ugh).

So far so good.

Hope this helps.

EdinBaltimore

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Edin,

Thank you for the great info and much appreciated perspective re: "over time"... I wondered about that.

Actually did have an mri guided biopsy = (3+4) in one location as a result of prostate mri = Central Gland: Heterogeneous signal with no high-grade malignancy by MRI. PI-RADS 2.

Peripheral Zone: There is a PI-RADS 4 lesion measuring 10 mm left posterior peripheral zone at the 5 o’clock location at the apex.

Seminal Vesicles: Normal.

Extracapsular Extension: None.

Urinary Bladder: Normal.

Lymph Nodes: No lymphadenopathy in the visualized pelvis by MRI. Bones: No abnormal marrow signal in the visualized pelvis.

Happy about your so far so good!

All the best,

Steve

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I had the Oncotype DX done 2 years ago after my first bx. I had a pretty low score, 19, so it helped me lean towards AS. It's a data point if your on the fence. A crazy journey is a good description.

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I was diagnosed in mid-May after biopsy with a G7 3+4. 10% pattern 4. All on left side. Second review of slides at Duke confirmed same. All clinical grading is T2A, but Duke URO graded me as a T2B and recommended immediate surgery, sampling of nodes, and no nerve-sparing on left side. Third review by Dr. Epstein downgraded pathology somewhat. Region of interest remained 3+4, but four other cores graded a 3+3. I had the Oncotype test because of little to no information regarding family history and to try to get a sense of urgency regarding time-to-treatment. My GPS score was 37 with a 56% chance of adverse pathology. Not great. I originally went to Duke for a second opinion consult and I'm currently being offered a position in a phase III trial to determine the efficacy of 25 dose IMRT vs 5 dose SBRT. I just can't rap my mind around surgery, although I've tried to look at all options without bias and my primary goal being the "cure". That being said, I'm leaning toward SBRT. In the most current NCCN treatment guidelines, I'm most likely looking at mono therapy. They also acknowledge the possibility of combo therapy for the potential of more aggressive disease. The Duke RO and MO are offering to continue consulting via phone/email so I sent my Oncotype and Dr. Epstein results to them for their thoughts on mono vs combo therapy.

Bottom line is that I'm curious to see if the Oncotype results has the potential to impact final treatment decision. I'll post my findings as they become available.

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I had just completed my genetic test (blood draw) by Invitae and reviewed the results with a geneticist. IMHO, genetic test will only be useful if one has aggressive and advanced PC, so tailored treatment can be considered. If you’re just at the beginning of PC state treatment, genetic testing is “useless” (again, my opinion), for these reasons: primary treatments are almost always surgical or radiation followed by ADT and sometimes chemo. Once it gets to the advanced stage (resistance and recurrence), you get newer drugs that may or may not be effective to manage the cancer. This when genetic test maybe useful, as second, or newer line of treatments may need to know if certain drugs will work. For example, the “hot new drugs” being clinically studied such as PARP inhibitors (drugs with “ab” and “ib”) depend on genetic positive or negative presence of BRCA1/2 mutations to be effective. BTW, mine is mostly negative findings on suspected PC-related mutations, which may explain why I am still responsive to Zytiga :-) for the past 16 months :-) .

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