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Applying Genetic Therapy
Genetic testing can indicate disease behavior, therapy success, and pre-disposal to prostate cancer. Therapies and decisions can be guided based on genetic profiles and knowledge of specific mutations. Discover genetic tests, genetically targeted therapies, and how to apply all this new, complex information to your prostate cancer.
Dr. Scholz: [00:04] Welcome to PROSTATE PROS. I’m Dr. Mark Scholz and this is my cohost, Liz Graves.
Liz: [00:11] This episode we’ll be talking about genetics and prostate cancer. There’s been an explosion of new technology and there are tons of new genetic companies popping up. How much of this is actually useful for prostate cancer patients?
Dr. Scholz: [00:24] Yeah, it’s amazing how many new companies have started up recently and we’re seeing a lot of the detail people coming through our office and touting these new tests, a simple blood test, perhaps a mouth swab, and you find out every gene known to man. What do we do with all this new information? Reflecting on this podcast, I thought that it would be sensible to work backwards from the tests that are specifically relevant to treatments or actions that would change as a result. It is possible to do testing and find a myriad of genes, but so many of them don’t have clinical relevance.
Liz: [01:05] Okay, so we have clinical relevance we need to address. There are two categories of application: there’s genetic testing for the newly diagnosed and genetic testing for advanced prostate cancer patients.
Dr. Scholz: [01:18] Yeah, so let’s address the newly diagnosed first. These tests have been around for over five years. There are three companies that are offering tests: Prolaris, Oncotype, and Decipher. These companies will evaluate the prostate biopsy, the information that was used to give you a Gleason Score originally and take that information and let you know if the cancer is likely to behave aggressively or not. This is scored out usually as a percentage likelihood that the cancer will progress or spread outside the prostate or even lead to death in the next 10 years. That’s useful information. The tricky part is that many times this information is validating what we already know from the Gleason Score, the PSA, and other scan results. The people who seem to be most benefited by this type of information are the men with favorable Gleason 7s. We call this Intermediate-Risk, with our color scheme we call it a Favorable-TEAL. They’re the people that are sort of at the tipping point: maybe they can watch it, maybe they have to treat it. One of these three tests can be helpful to point to whether or not the disease is likely to be aggressive in the future in that specific individual.
Liz: [02:44] So they can really help people be confident in the decisions they’re making, whether they’re thinking about being an active surveillance patient or deciding on treatment.
Dr. Scholz: [02:52] Exactly, this historically was very important because when active surveillance first came on the horizon about 10 years ago, it was such a unique and unexpected idea to just simply monitor people. So to have genetic testing that would validate the safety of that approach was extremely valuable. Now of course, more and more it’s becoming mainstream to do active surveillance in Grade 6 patients. I am not using the tests as aggressively in Grade 6 patients because we now have a greater level of comfort doing active surveillance in these patients. Do we really need another test to tell us what we kind of already know? It’s certainly okay to do the testing and nervous patients will still want to do the test to confirm that it is safe to do active surveillance. But, as I mentioned previously, it’s really the favorable Grade 7s where people can go either way that we really appreciate having this type of information.
Liz: [03:57] S
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By Mark Scholz, MD
4.8
3737 ratings
Genetic testing can indicate disease behavior, therapy success, and pre-disposal to prostate cancer. Therapies and decisions can be guided based on genetic profiles and knowledge of specific mutations. Discover genetic tests, genetically targeted therapies, and how to apply all this new, complex information to your prostate cancer.
Dr. Scholz: [00:04] Welcome to PROSTATE PROS. I’m Dr. Mark Scholz and this is my cohost, Liz Graves.
Liz: [00:11] This episode we’ll be talking about genetics and prostate cancer. There’s been an explosion of new technology and there are tons of new genetic companies popping up. How much of this is actually useful for prostate cancer patients?
Dr. Scholz: [00:24] Yeah, it’s amazing how many new companies have started up recently and we’re seeing a lot of the detail people coming through our office and touting these new tests, a simple blood test, perhaps a mouth swab, and you find out every gene known to man. What do we do with all this new information? Reflecting on this podcast, I thought that it would be sensible to work backwards from the tests that are specifically relevant to treatments or actions that would change as a result. It is possible to do testing and find a myriad of genes, but so many of them don’t have clinical relevance.
Liz: [01:05] Okay, so we have clinical relevance we need to address. There are two categories of application: there’s genetic testing for the newly diagnosed and genetic testing for advanced prostate cancer patients.
Dr. Scholz: [01:18] Yeah, so let’s address the newly diagnosed first. These tests have been around for over five years. There are three companies that are offering tests: Prolaris, Oncotype, and Decipher. These companies will evaluate the prostate biopsy, the information that was used to give you a Gleason Score originally and take that information and let you know if the cancer is likely to behave aggressively or not. This is scored out usually as a percentage likelihood that the cancer will progress or spread outside the prostate or even lead to death in the next 10 years. That’s useful information. The tricky part is that many times this information is validating what we already know from the Gleason Score, the PSA, and other scan results. The people who seem to be most benefited by this type of information are the men with favorable Gleason 7s. We call this Intermediate-Risk, with our color scheme we call it a Favorable-TEAL. They’re the people that are sort of at the tipping point: maybe they can watch it, maybe they have to treat it. One of these three tests can be helpful to point to whether or not the disease is likely to be aggressive in the future in that specific individual.
Liz: [02:44] So they can really help people be confident in the decisions they’re making, whether they’re thinking about being an active surveillance patient or deciding on treatment.
Dr. Scholz: [02:52] Exactly, this historically was very important because when active surveillance first came on the horizon about 10 years ago, it was such a unique and unexpected idea to just simply monitor people. So to have genetic testing that would validate the safety of that approach was extremely valuable. Now of course, more and more it’s becoming mainstream to do active surveillance in Grade 6 patients. I am not using the tests as aggressively in Grade 6 patients because we now have a greater level of comfort doing active surveillance in these patients. Do we really need another test to tell us what we kind of already know? It’s certainly okay to do the testing and nervous patients will still want to do the test to confirm that it is safe to do active surveillance. But, as I mentioned previously, it’s really the favorable Grade 7s where people can go either way that we really appreciate having this type of information.
Liz: [03:57] S