Biomarkers for Aiding Risk Stratification and Treatment Decisions

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Once diagnosed with prostate cancer, a patient and his urology team must work together to make an informed choice about next steps. The Gleason score and prostate-specific antigen (PSA) levels can provide some guidance on which patients should be treated versus which can be monitored under an active surveillance program. In addition to these tests, genetic assays are available that may help to risk-stratify patients at the time of diagnosis.

Genomic Health created a final 17-gene Oncotype DX prostate cancer assay that is predictive of clinical recurrence (local recurrence and/or metastatic disease) and predictive of aggressive prostate cancer in the face of tumor heterogeneity and multifocality. Combined with other tests and indices, Oncotype DX’s resulting Genomic Prostate Score (GPS) can direct discussions about treatment options.

Decipher genomic classifier, developed by GenomeDX Biosciences, can also predict the probability of metastasis after surgery and provides an independent assessment of tumor aggressiveness—information distinct from that provided by a Gleason score or PSA test.

Another useful genetic test is Prolaris, developed by Myriad Genetics, which provides a quantitative measure of the RNA expression levels of multiple genes related to the progression of tumor cell division. Now included in the National Comprehendsive Cancer Network guidelines for prostate cancer, Prolaris can help risk-stratify patients further. Currently, decisions are often made using evidence from population-based data. These types of biomarkers tests can aid in risk-stratifying patients and directing care at a genomic level.