Post RP Genomic testing to determine likelihood of disease recurrence

ZeeQueFarm · February 2016

Folks,

I am a new RP patient. My cancer was detected in October 2015, and I just had a robotic RP January 26, 2016. I have not read my pathology report, but the doctor did give me a good news/bad news phone call. Good news was no lymph node involvement, bad news was a positive margin. So I don't have any details of what that margin entails. I can share them when I get them. This report is a disappointment in that it leaves us with a clouded recovery future, which was always possible anyway. We just were hoping for a clean report. Anyhow, I can sympathize with the angst of the posters over that first 3 month PSA. This angst apparently does not go away as the recurrence fear stays with you for life.

What I'd like to know is this, has anyone pursued, or been made aware of some of the new genomic tests for prostate cancer? There is one in particular called Decipher, that evaluates the genomic makeup of the cancer in your tumor. It would seem that an indolent cancer has a different genomic pattern than one that leans toward metastasis.

Johns Hopkins Brady Clinic has a paper on the test here, http://urology.jhu.edu/prostate/prostate_cancer_genomic.php

And here is the company's website for the product, http://deciphertest.com/managing-the-journey-after-surgery/genomics-in-prostate-cancer/

My plan is to have a chat with my doctor about the benefit of this test. Since I got my diagnosis, the quest for as much information as possible about my condition has helped me get through to this point. Don't see why that knowledge quest should stop now.

Thoughts, comments?

thx

hopeful and optimistic · February 2016

Genomic testing

There are about 8 or 9 different genomic tests new to the market for prostate cancer. The results of these diagnostic tests, although not stand alone, gives more input to the patients condition, and need to be evaluated along with other diagnostic tests that have been, and need to be done, such as the post surgery PSA .

I am not familiar with the Decipher test, however it may be worth pursuing.

I read your "about me page", and you mentioned that you had two cores that were positive, one being a 3+3=6 and the the other being a 3+4=7. I wonder what is the involvement of each of those core, that is what percent of each core was cancerous? Was there any other pertinent information stated in the biopsy?

Did you have any other diagnostic tests, and what were the results? For example T3 MRI, PCA3, geonomic test of your biopsy, etc.....pSA history, DRE results?

Best wishes for recovery,

h

VascodaGama · February 2016

Good news/bad news

Zee

Welcome to the board. I think you doing well in getting the genomic test even if your doctor doesn't opinion in that way. In the past 5 years, there have been increasing researches on the use of our DNA to tract the most suitable treatment/medication for our illnesses, at an individual bases. What is good for me may not produce the same effect on you. However, the present genomic based exams (diagnosis and therapies) are not yet "perfect" for one to trust it in finding about future recurrences. It can help in identifying worse types of cancerous cells but do not identify a case of metastases/spread.
This test may be benefitial to prioritize patients for the modality of a conbi salvage treatment that includes RT plus HT, when RP fails.

In any case, the news regarding the existing "positive margin" may not be as bad as you may think. Positive margins exist in all radical prostatectomies. Typically the prostate outer skin retreats at the places of dissection from other tissues, (at the sphincter and at the colon), which is indicated by the pathologist as "positive margins". These are surgical margins which are inspected under the microscope to look for the presence of cancer. Positive margins at other areas of the prostate could be a cause of negligence done by the surgeon (too much cutting) or it could exist if cancer has perforated the shell. In such a case pathologists indicate in the report this finding using the term of "Positive extra capsular extensions" (the bad news).

The "no lymph node involvement" is good news but it relates to the lymph nodes dissected, typically close to the prostate gland. The Robot arm in RP do not reach all localized lymph nodes, particularly the ones at the iliac. These are typically dissected in open surgeries when the patient is found with higher Gleason grades of 4 and 5; Therefore, with more possibilities/risks for metastases.

The best marker to ascertain RP success is still the PSA curve if the patient has a type of cancer that produces normal levels of the serum. Our body also takes time to "clean" the PSA "debris" so that the best time to get the test will be from two weeks post operation. Remission indicating success is a threshold lower than 0.06. An increase curve from periodical tests is taken as chemical failure. When the PSA reaches a level of 0.20 ng/ml the case is considered as "recurrence" (RP failure).

Best wishes for a successful outcome.

VG

ZeeQueFarm · February 2016

hopeful and optimistic said:
Genomic testing
There are about 8 or 9 different genomic tests new to the market for prostate cancer. The results of these diagnostic tests, although not stand alone, gives more input to the patients condition, and need to be evaluated along with other diagnostic tests that have been, and need to be done, such as the post surgery PSA .

I am not familiar with the Decipher test, however it may be worth pursuing.

I read your "about me page", and you mentioned that you had two cores that were positive, one being a 3+3=6 and the the other being a 3+4=7. I wonder what is the involvement of each of those core, that is what percent of each core was cancerous? Was there any other pertinent information stated in the biopsy?

Did you have any other diagnostic tests, and what were the results? For example T3 MRI, PCA3, geonomic test of your biopsy, etc.....pSA history, DRE results?

Best wishes for recovery,

h

Other details of my case

Hopeful,

Thanx for the good wishes. As an update to my post, I had my catheter pulled this past Saturday. Within 2 hours I needed to urinate. I was able to stop/start my stream 3 times successfully, thanked God, and cried. I was prepared for months of fighting incontinence, and here on my first attempt I seemed to be in full control. I truly feel blessed and give credit to my surgical team at Johns Hopkins for sparing my nerves. Hopefully another important function will meet the same result. In time, we shall see.

The reason for my biopsy was a spike in my PSA detected in my annual physical, from 3.85 to 6.4. My primary care doctor wanted to retest to be sure, and the PSA was still > 6 so he sent me to see a urologist. And that is how I ended up with a biopsy. There were no other tests. As for my biopsy detail. The GS 7 core had a 40% involvement; the GS 6 core was %. So being a 3+4 and only 1 troubling core of <50%, I tried very hard to go on active surveillance. My wife is a nurse so I was able to access medical libraries to get data from current journals, studies, etc. Having a lower grade gleason with only 2 cores affected led me to believe I could go on AS. My doctor at Hopkins listened patiently to all of my arguments, answering all my questions, but he explained the overriding factor that kept me out of AS was my PSA density (PSAD). Mine was more than double the recommended value for AS. You divide your PSA (mine 6.4) by the volume of the prostate (mine 25 mg), resulting in a value of 0.24.

I believe that a PSAD >0.15 indicates a more aggressive tumor. Less than allows you to be a candidate for AS.

This was a huge disappointment to me, but I could not argue the values, and went forward with the surgery.

ZeeQueFarm · February 2016

VascodaGama said:
Good news/bad news
Zee

Welcome to the board. I think you doing well in getting the genomic test even if your doctor doesn't opinion in that way. In the past 5 years, there have been increasing researches on the use of our DNA to tract the most suitable treatment/medication for our illnesses, at an individual bases. What is good for me may not produce the same effect on you. However, the present genomic based exams (diagnosis and therapies) are not yet "perfect" for one to trust it in finding about future recurrences. It can help in identifying worse types of cancerous cells but do not identify a case of metastases/spread.
This test may be benefitial to prioritize patients for the modality of a conbi salvage treatment that includes RT plus HT, when RP fails.

In any case, the news regarding the existing "positive margin" may not be as bad as you may think. Positive margins exist in all radical prostatectomies. Typically the prostate outer skin retreats at the places of dissection from other tissues, (at the sphincter and at the colon), which is indicated by the pathologist as "positive margins". These are surgical margins which are inspected under the microscope to look for the presence of cancer. Positive margins at other areas of the prostate could be a cause of negligence done by the surgeon (too much cutting) or it could exist if cancer has perforated the shell. In such a case pathologists indicate in the report this finding using the term of "Positive extra capsular extensions" (the bad news).

The "no lymph node involvement" is good news but it relates to the lymph nodes dissected, typically close to the prostate gland. The Robot arm in RP do not reach all localized lymph nodes, particularly the ones at the iliac. These are typically dissected in open surgeries when the patient is found with higher Gleason grades of 4 and 5; Therefore, with more possibilities/risks for metastases.

The best marker to ascertain RP success is still the PSA curve if the patient has a type of cancer that produces normal levels of the serum. Our body also takes time to "clean" the PSA "debris" so that the best time to get the test will be from two weeks post operation. Remission indicating success is a threshold lower than 0.06. An increase curve from periodical tests is taken as chemical failure. When the PSA reaches a level of 0.20 ng/ml the case is considered as "recurrence" (RP failure).

Best wishes for a successful outcome.

VG

VG,
Thanx for the reply and

VG,

Thanx for the reply and wishes. Good data in your post. I want to lean toward the positive, so we were a little disappointed not getting a totally clean pathology. Your reply helps on the optimism side of the equation.

I'd also like to say that finding this board has been very helpful to me. Reading all the various posts is not only interesting and helpful, but the community is quite heart warming especially in this time of need.

thx again

hopeful and optimistic · February 2016

Decipher,

By the way , quite often when these genomic tests are developed it takes some time to be approved, so during that time you do not have to pay for the test.

In the event that your PSA test after the surgery, is not what you would want, at that time there are various state of the art pet scans availalbe to determine where the cancer(s) is. There are various PSA requirements for these tests.

http://csn.cancer.org/node/298513

Although you did not enroll in an Active Surveillance program, so far you are doing well with the aftermath of your surgery. Did Johns hopkins speak to you about what you need to do to retain sexual capability , if necessary in your case.

Post RP Genomic testing to determine likelihood of disease recurrence

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