Prostate Cancer: Can You Watch and Wait?

New genetic test identifies low-risk patients

Older man with glasses

When a man is diagnosed with prostate cancer, the first question that comes to mind may be, “How soon can I be treated?”

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But treatment isn’t always the answer, especially for low-risk cases. That’s why the Oncotype DX Prostate Cancer Test made headlines when it was announced last month. The test is designed to determine which men need immediate treatment and which men can watch and wait.

Why it matters

Prostate surgery and radiation therapy sometimes come with side effects that change a man’s life, including incontinence and impotence in some cases. When serious prostate cancer is likely to take a man’s life, too, those side effects may be less of a concern.

But what about low-risk cases? As my colleague Eric Klein, MD, who led development studies for the Oncotype DX Prostate Test, noted recently on Health Hub, around 90 percent of low-risk patients have treatment even though the chances of their cancer becoming deadly is less than 3 percent.

“It’s not easy to choose to leave cancer in your body. However, having the right information available can help you and your doctors make the best possible decisions — especially when they are difficult.”

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Charis Eng, MD, PhD

Founding Chairwoman of the Genomic Medicine Institute

Why? Because of a lack of information.

For example, two tumors may have the same Gleason score — today’s standard measurement for prostate cancer — but one will grow aggressively while the other grows slowly. The Oncotype DX test uses genetics to tell the difference.

Is your cancer aggressive or low-risk?

I’ve talked a lot about the role of your personal genetics, meaning what you inherit and pass down to your children, in the past. This is different. The Oncotype DX test focuses on the cancer itself.

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The test measures the expression of 17 genes in prostate cancer tissue to predict how quickly your cancer might grow. If the results show aggressive cancer, you can get the treatment you need right away.

If your results show low-risk cancer, you may benefit even more. You can avoid unnecessary treatment and side effects. Instead, you can choose “active surveillance,” a regimen of regular appointments, PSAs, biopsies and follow-up tests coordinated by your doctors.

Will it be the new norm?

Whether Oncotype DX for prostate cancer becomes widespread remains to be seen. But there is a blueprint from the past: the Oncotype DX Breast Cancer Test.

This breast cancer test, similar to the new prostate test, has become standard care in just a few short years. It helps to identify which women will benefit from certain treatments, and which do not need further treatment after surgery. In other words, it can improve treatment and save costs. That’s why many insurance companies have embraced it.

The same may happen for the prostate cancer test. But men will have to embrace it, too, for it to be truly helpful. It’s not easy to choose to leave cancer in your body. However, having the right information available can help you and your doctors make the best possible decisions — especially when they are difficult.

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Charis Eng, MD, PhD

Charis Eng, MD, PhD

Charis Eng, MD, PhD is founding chairwoman of the Genomic Medicine Institute and founding director of its Center for Personalized Genetic Healthcare. Dr. Eng is a global leader in cancer genetics and cancer genomic medicine.
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