How can genomic testing help?
Genomic tests are relatively new but are already finding their place in the management of men with prostate cancer.
What is genomic testing?
A genomic test detects and measures subtle genetic changes in your tumor generating information that can help physicians determine how best to treat your disease.
Genomic tests that are performed after initial treatment are used to answer questions such as "what is the likelihood my cancer will come back and/or spread?" This is done by measuring molecular clues, or biological markers, in the tumor. PSA is an example of a molecular clue found in the blood. Whereas a test for PSA provides information about one molecular marker, a genomic test scours the central machinery of the tumor cells to find and attempt to read millions of molecular markers. Researchers at Johns Hopkins studied one such genomic test called the Decipher® Prostate Cancer Classifier to gain a deeper understanding of why some tumors are more aggressive than others. This new information can be used to aid treatment decision–making after surgery.
Decipher measures over one million different pieces of data at one time. Currently, men who are considered higher-risk after surgery and receive the test will review with their doctor results from an important subset of those data points, which have been shown to specifically predict metastasis, or disease spread, after surgery. Ongoing clinical studies conducted by researchers from Johns Hopkins and other leading cancer institutes are using genomic testing to look across those millions of data points to advance our understanding of how this information can help prostate cancer patients in new ways.
What is the Decipher Prostate Cancer Classifier and who might benefit from the test?
Decipher is for men with any of the following after surgery: positive surgical margins, extraprostatic extension, seminal vesicle invasion and/or a rising PSA.
Most of the men treated with prostate surgery at Johns Hopkins are unlikely to have any of the above signs of residual disease and will remain cancer free. A test like Decipher may be useful in those men who present with signs that more aggressive cancer may remain in their body. Decipher predicts the probability that the cancer will metastasize (grow and spread) for any individual patient.
What do the results of a genomic test tell the patient?
Decipher measures the tumor's biological potential for metastasis and spread.
A Decipher result is reported as a percentage risk of metastasis that categorizes men as either high or low risk based on the genomics of their individual cancer. If, for example, the Decipher result comes back as genomic low risk, it may mean that the patient can be closely observed after surgery and forego or delay any additional treatment. Multiple validation studies of the test have shown that men in this category have a very low risk of developing metastasis and clinical study evidence suggests that their outcomes will not be compromised if treatment is delayed.
Conversely, if the Decipher risk is high, clinical evidence suggests that treating with radiation soon after surgery improves metastasis-free survival. On average, men in this genomic high-risk group had an 80% reduction in metastasis risk when treated early over men who delayed treatment.
Learn more about Decipher here: www.DecipherTest.com
Why are genomic tests considered "personalized" medicine?
The development of new and individualized ways to understand prostate cancer risk is important because we know that not all cancer is the same. The pathology report and PSA test are important guides for physicians, but they do not tell the whole story.
Prostate cancer tumors are made up of the same unique DNA as the patients carrying them, which is one of the reasons their behavior is not always easy to predict. It is also a reason why it makes sense to use genomic testing to "listen" to the DNA activity to see what it is telling us about an individual patient's cancer.
Genomic testing can help physicians and patients make more informed decisions about management and treatment by arming them with more accurate, personalized information about the course of a patient's disease.