I recently came across the following menu of prostate cancer diagnostic tests offered by a specific facility. The tests are mainly used to identify those cancers that may be aggressive requiring further biopsies or treatment. The first group of tests would be applicable to men whose PSA values indicate the possibility of cancer while the second group are biopsy-based. This information should be discussed in conjunction with your personal physician and your personal insurance carriers as to need for the tests, their availability, costs and insurance coverage. Information concerning these tests is also available in earlier blogs on this website. To find them, simply insert the test name into the search engine on the home page. In addition, the latest edition of the Prostate Cancer Research Institute (PCRI) Insights (see link) contained an excellent review article discussing all the current prostate MRI techniques.
Post-PSA Diagnostic Testing:
4K Score: This test measures four prostate-specific kallikreins in the blood: Total PSA, FREE PSA, Intact PSA and Human Kallikrein 2 (hK2). Results are combined with patient age, digital rectal exam (nodule, no nodule) and prior negative biopsy results (yes, no). The tests then provides a % probability on a scale of 1%-95% for the patient having high-grade prostate cancer. The 4K Score is designed specifically to reduce the number of unnecessary negative biopsies that detect low-grade cancer. This means not all men who have an elevated PSA will require a biopsy.
PCA3 Score: This is a simple urine sample collected following a digital rectal exam for the determination of the PCA3 score. Specific for prostate cancer, and, unlike the PSA, this test is not affected by prostate enlargement or other non-cancerous prostate conditions. In combination with PSA and digital rectal exam (DRE) results, the PCA3 score provides useful information to help decide if a biopsy is needed, or can be delayed. It’s much more specific in giving additional information about the aggressiveness of the cancer if the patient has a positive biopsy.
Post-Biopsy Genetic Testing:
MRI-Guided Biopsy: An MRI-ultrasound fusion biopsy involves taking an MRI and then fusing the data with real-time ultrasound images for guidance on biopsy procedures. While there are several types of MRI-guided biopsy techniques, one such system, the UroNav Fusion Biopsy System combines electromagnetic tracking and navigation with an onboard computer and a real-time imaging interface in one mobile workstation. The MR/Ultrasound fusion aligns and registers prior diagnostic MR images with real-time ultrasound images. For a more comprehensive MRI review, see the following link.
Oncotype DX: The Oncotype DX Genomic Prostate Score is a biopsy-based genetic test that can be combined with other measures to predict the aggressiveness of prostate cancer. The test applies advanced genomic science to reveal the unique biology of a tumor in order to optimize cancer treatment decisions for each individual patient. The test is a multi-gene RT-PCR expression analysis developed to work in combination with prostate needle biopsies. It measures the expression of 12 cancer-related genes representing four biological pathways and 5 reference genes, which are then combined to calculate the Genomic Prostate Score (GPX). This biopsy-based score has been clinically validated as a predictor of aggressive prostate cancer. Three studies presented at the 110thAnnual Scientific Meeting of the American Urological Association this year showed this test improved risk assessment for patients and reduces cost of prostate cancer care. This test also is helping to examine further the biology and development of prostate cancer in African American men who are at a high risk for the disease.
Prolaris and Genomic Prostate Score: The purpose of this score is to distinguish between aggressive cancers that need treatment and those that are slow growing and may need active surveillance. The Prolaris Score is a measure of how fast a prostate cancer tumor is growing after a biopsy has indicated its presence in the prostate gland. Biopsy tissue samples are used to determine a patient’s personal Prolaris Score. It measures how fast cancer cells in the tumor are dividing. Measuring a 46-gene expression signature, Prolaris also includes cell cycle progression genes selected based upon correlation with prostate tumor cell proliferation.
Confirm MDx: A genetic test rooted in the field of epigenetics, identifies key changes in gene activity for a negative biopsy or results showing high-grade PIN or ASAP. ConfirmMDx was developed to help reduce unnecessary repeat biopsies through its support of the negative predictive value (NPV). Clinical trials showed this test to be the most significant independent predictor for prostate cancer detection on repeat biopsy. A risk score for ConfirmMDx methylation-positive men was developed to increase the positive predictive value (PPV), which helps identify those with aggressive prostate cancer. This test combines these risk scores along with epigenetic profiling and strongly correlates with the detection of aggressive prostate cancer upon repeat biopsy.