Biopsy accuracy? Genetic testing of biopsy tissue = 2nd opinion options

choclabs
choclabs Member Posts: 23
in Prostate Cancer #1

Here are 2 articles regarding the advances in gentic testing of biopsy tissue that help to determine the "$64,000 dollar question".

The "$64,000 dollar question" is this - is my PCa a slow growth non aggressive type or is my PCa the fast growth aggressive type? This is obviously the "holy grail" of PCa pathology as it can directly affect the decision tree of treatments which all of us who have PCa currently face. More importantly = when to initiate aggressive treatment options such as surgery or External Beam Radiology treatments. We would all like to have a test that tells us our cancer is fully contained and encapsulated within the prostate and will remain that way. However that definitive of a test, as of now,  just aint available to us. FYI - Bostwick Labs ProstaVysion is an in network lab with UnitedHealtcare insurance and has been mentioned a couple of times or more by one of our forum members.

Overview of genetic tests that focus on differention of PCa types are coming or are available -

New Prostate Cancer Tests Could Reduce False Alarms

http://www.nytimes.com/2013/03/27/business/new-prostate-cancer-tests-may-supplement-psa-testing.html?pagewanted=all

Follow-up article focus on Oncotype DX and Prolaris tests -

New Test Improves Assessment of Prostate Cancer Risk, Study Says

http://www.nytimes.com/2013/05/08/business/prostate-cancer-test-from-genomic-health-assesses-risks.html?_r=0

 

Comments

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,817 Member
    #2
    H&A

    Hopeful and Optimistic at least indirectly wrote a post on your other that addresses your question here.

    MOST biopsies are accurate to begin with. Most new diagnostic tools, although touted as revolutionary, are usually in fact only minimally better than what existed before.  Except in cases where the doctors themselves admit ambiguity or confusion over biopsy results, I would not bother to get any further testing done on the cores.  Just me.  No test is ever going to give you a certified guarantee that no PCa has exited the gland, ever.  What we can all get is a high level of certainty that such is the case, and move forward from there.

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #3
    Moving in the right direction

    The "holy grail" of PCa pathology.......................

    We all experience frustration in the initial stage of our journey. This is the time when we have been diagnosed with PCa by the experts but then the advices from them become sparse. The ball is now in our hands and we don’t know what to do next. We are not doctors and have no knowledge to solve the problem.
    The best one can do is to investigate and try learning as much as possible. Errors are permissible. In parallel we may look for means of identifying our real status.

    I think you are on the right path to formulate your decision. Finding about the aggressiveness of the cancer and getting the best “picture” of its location to move on to a therapy may be the “holy grail” of the best decision. Pathologists can identify cancer in a biopsy but examining the tissues in twelve needles alone doesn’t mean one got the status of the whole gland.
    In any case, the results from the biopsy together with any findings of existing BPH, the results of DRE, the PSA histology and the results from image studies may provide an “answer” that will be close enough to the real status. These collections of data should be obtained from reliable institutions, experienced doctors and modern methods of examination.

    Your family may be the best source for support. Try involving them in the discussions.

    Best wishes and peace of mind.

    VG

     

  • choclabs
    choclabs Member Posts: 23
    #4
    VascodaGama said:

    Moving in the right direction

    The "holy grail" of PCa pathology.......................

    We all experience frustration in the initial stage of our journey. This is the time when we have been diagnosed with PCa by the experts but then the advices from them become sparse. The ball is now in our hands and we don’t know what to do next. We are not doctors and have no knowledge to solve the problem.
    The best one can do is to investigate and try learning as much as possible. Errors are permissible. In parallel we may look for means of identifying our real status.

    I think you are on the right path to formulate your decision. Finding about the aggressiveness of the cancer and getting the best “picture” of its location to move on to a therapy may be the “holy grail” of the best decision. Pathologists can identify cancer in a biopsy but examining the tissues in twelve needles alone doesn’t mean one got the status of the whole gland.
    In any case, the results from the biopsy together with any findings of existing BPH, the results of DRE, the PSA histology and the results from image studies may provide an “answer” that will be close enough to the real status. These collections of data should be obtained from reliable institutions, experienced doctors and modern methods of examination.

    Your family may be the best source for support. Try involving them in the discussions.

    Best wishes and peace of mind.

    VG

     

    too soon to tell

    It is my opinion that these tests are most helpful for those patients that land in the Gleason 6 and Gleason 7 zone. I do beleive that the genetic tests have the ability to expand on the curent standards of family history, PSA, DRE and standard microscope based inspection of biopsy tissue. The additional information is most appropriate when one is making a decision between AS and aggressive treatment.

    I am curious at to why MDA dose not offer the possibility of recommending one or more of these tests as ancillary and valueable information for GS 6 and 7 patients, and I will ask them.

    In my case family history of PCa = none and all other cancers = very few, DRE = nothing detected, BPH and PSA over 4 since 2004, PSA over 10 since 2014, biopsy 2 samples out of 12 = cancer. All other imaging including a bone scan = no cancer detected outside of prostate.

    Some of you may wonder why I posted this information, it is because our community needs to be aware of all diagnostic tools available and what the progression of these tools in the area of accuracy is becoming. I have no false impressions that IF one or more of these tests came back and indicated that I MIGHT be in more of a GS 6 than a GS 7 that I will not eventually get therapy. And since I am at a 3+4 = 7, it is only a matter of time before that number gets higher, UNLESS my focus on a nutritional approach which dramatically ramps up the health of my immune system actually begins to reduce the size of my prostate and therefore the PSA value.

    So the bottom line is this, do these tools provide a newly diagnosed PCa patient with better time management information? Do these tests help someone answer, is my cancer in the 80% bracket of slow growth?

    I am fully resigned to the fact that I have cancer and I am heading towards a treatment plan. I am getting quite comfortable with my research to this point. All of my family is onboard with their full support and I have shared with them what I am finding, plus my RO is great with direct communication with my wife.

    BTW - I graduated with a BS in Electronics Engineering Technology, so I am gonna perform research but not to the point of analysis paralysis.

    Thanks again to those of you who are sharing your experience with these issues.

    Michael

     

     

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    #5
    choclabs said:

    too soon to tell

    It is my opinion that these tests are most helpful for those patients that land in the Gleason 6 and Gleason 7 zone. I do beleive that the genetic tests have the ability to expand on the curent standards of family history, PSA, DRE and standard microscope based inspection of biopsy tissue. The additional information is most appropriate when one is making a decision between AS and aggressive treatment.

    I am curious at to why MDA dose not offer the possibility of recommending one or more of these tests as ancillary and valueable information for GS 6 and 7 patients, and I will ask them.

    In my case family history of PCa = none and all other cancers = very few, DRE = nothing detected, BPH and PSA over 4 since 2004, PSA over 10 since 2014, biopsy 2 samples out of 12 = cancer. All other imaging including a bone scan = no cancer detected outside of prostate.

    Some of you may wonder why I posted this information, it is because our community needs to be aware of all diagnostic tools available and what the progression of these tools in the area of accuracy is becoming. I have no false impressions that IF one or more of these tests came back and indicated that I MIGHT be in more of a GS 6 than a GS 7 that I will not eventually get therapy. And since I am at a 3+4 = 7, it is only a matter of time before that number gets higher, UNLESS my focus on a nutritional approach which dramatically ramps up the health of my immune system actually begins to reduce the size of my prostate and therefore the PSA value.

    So the bottom line is this, do these tools provide a newly diagnosed PCa patient with better time management information? Do these tests help someone answer, is my cancer in the 80% bracket of slow growth?

    I am fully resigned to the fact that I have cancer and I am heading towards a treatment plan. I am getting quite comfortable with my research to this point. All of my family is onboard with their full support and I have shared with them what I am finding, plus my RO is great with direct communication with my wife.

    BTW - I graduated with a BS in Electronics Engineering Technology, so I am gonna perform research but not to the point of analysis paralysis.

    Thanks again to those of you who are sharing your experience with these issues.

    Michael

     

     

    Oncotype DX test

    Michael,

    You are correct in stating that the Oncotype DX test result may be helpful in the decision process whether to enter an Active Surveillance (AS) program. One reason for the reluctance of the MD Andersen staff to mention the test is that they believe that the test has not been sufficienty validated in true scientific fashion with appropriate controls and publication in peer-reviewed journals.

    Another reason could be the thought that if a (low-risk) patient enters an Active Surveillance program, he will be watched carefully (scans, PSA, etc). And if the cancer does become a problem after some time in the program, therapy will be initiated in a timely fashion. Nothing lost by not doing the Oncotype test and gaining perhaps a few years of 'easy living'.

    Just speculating!

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