New prostate cancer test gauges aggressiveness

Treat or monitor? It's a difficult decision prostate cancer patients and doctors must make based on how aggressive they think a tumor might be. But new genetic tests could lessen the guessing game and spare some men the side effects of treatment. (May 8)

A new genetic test to gauge the aggressiveness of prostate cancer may help tens of thousands of men each year decide whether they need to treat their cancer right away or can safely monitor it.

The new test, which goes on sale today, joins another one that recently came on the market. Both analyze multiple genes in a biopsy sample and give a score for aggressiveness, similar to tests used now for certain breast and colon cancers.

Doctors say tests like these have the potential to curb a major problem in cancer care -- overtreatment. Prostate tumors usually grow so slowly they will never threaten a man's life, but some prove fatal and there is no reliable way now to tell which ones will. Treatment with surgery, radiation or hormone blockers isn't needed in most cases and can cause impotence or incontinence, yet most men are afraid to skip it.


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"We're not giving patients enough information to make their decision," said Dr. Peter Carroll, chairman of urology at the University of California, San Francisco. "You can shop for a toaster" better than for prostate treatment, he said.

A study he led of the newest test -- the Oncotype DX Genomic Prostate Score -- is set for discussion today at an American Urological Association meeting in San Diego.

The results suggest the test could triple the number of men thought to be at such low risk for aggressive disease that monitoring is a clearly safe option. Conversely, the test also suggested some tumors were more aggressive than doctors had believed.

Independent experts say such a test is desperately needed but that it's unclear how much information this one adds or whether it will be enough to persuade men with low-risk tumors to forgo treatment, and treat it only if it gets worse. Only 10 percent who are candidates for monitoring choose it now.

"The question is, what's the magnitude of difference that would change the patient's mind?" said Dr. Bruce Roth, a cancer specialist at Washington University in St. Louis.

One man may view a 15 percent chance that his tumor is aggressive as low risk "but someone else might say, 'Oh my God, let's set the surgery up tomorrow,' " he said. "I don't think it's a slam dunk."

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