This week Dr. Samadi’s Prostate Cancer Center announced that it is now offering a range of genetic tests that will assess a patient’s risk for prostate cancer (PC), as well as, more effectively diagnosis disease, both pre-biopsy and post-biopsy.
- Prostate-specific antigen (PSA): is a substance produced by the prostate gland. Elevated PSA levels may indicate prostate cancer, a noncancerous condition such as prostatitis, or an enlarged prostate.
- Biomarkers: short for biological markers, are the measures used to perform a clinical assessment- examples include blood pressure or PSA levels, that are used to monitor and predict patient’s health status
Dr. David B. Samadi, MD, is a board certified urologic oncologist trained in open traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is Chairman of Urology, Chief of Robotic Surgery at Lenox Hill Hospital, Professor of Urology at Hofstra North Shore-LIJ School of Medicine. He has dedicated his distinguished career to the early detection, diagnosis and treatment of prostate cancer and is considered one of the most prominent surgeons in his field.
In the announcement press release, Dr. Samadi stated, “We’re very excited to now offer these revolutionary genetic tests to men with an elevated PSA or after a biopsy. Thanks to these innovative methods, we’re getting smarter when it comes to diagnosing prostate cancer. This is a major shift in this field, especially when it comes to distinguishing between aggressive and low-grade cancers.”
Dr. Samadi, continued, “Now that we’ve moved from Ultrasound to MRI, in combination with these genetic tests, we may actually be to able crack the code and diagnose aggressive prostate cancer earlier. And of course, this leads to the right treatment path for each patient. We’re confident this new era of personalized medicine combined with genetic testing will better detect and distinguish aggressive prostate cancer, leading to the right treatment for each patient. The foundation stems from individualized care, even when it comes to treating a disease that is this prominent.”
Post-PSA Diagnostic Testing
- 4K Score: This test measures four prostate-specific kallikreins in the blood: Total PSA, FREE PSA, Intact PSA and Human Kallikrein 2 (hK2). Results are combined with patient age, digital rectal exam (nodule, no nodule) and prior negative biopsy results (yes, no). The tests then provides a % probability on a scale of 1%-95% for the patient having high-grade prostate cancer. The 4K Score is designed specifically to reduce the number of unnecessary negative biopsies that detect low-grade cancer. This means not all men who have an elevated PSA will require a biopsy.
- PCA3 Score: This is a simple urine sample collected following a digital rectal exam for the determination of the PCA3 score. Specific for prostate cancer, and, unlike the PSA, this test is not affected by prostate enlargement or other non-cancerous prostate conditions. In combination with PSA and DRE results, the PCA3 score provides useful information to help decide if a biopsy is needed, or can be delayed. It’s much more specific in giving additional information about the aggressiveness of the cancer if the patient has a positive biopsy.
Post-Biopsy Genetic Testing
- MRI Guided Biopsy: Dr. Samadi’s Prostate Cancer Center is the only center inNew York City using the revolutionary Uronav Fusion Biopsy System for MRI-Guided Biopsy. An MRI-ultrasound fusion biopsy involves taking an MRI and then fusing the data with real-time ultrasound images for guidance on biopsy procedures. The UroNav System combines electromagnetic tracking and navigation with an onboard computer and a real-time imaging interface in one mobile workstation. The MR/Ultrasound fusion aligns and registers prior diagnostic MR images with real-time ultrasound images.
- Oncotype DX: The Oncotype DX Genomic Prostate Score is a biopsy-based genetic test that can be combined with other measures to predict the aggressiveness of prostate cancer. The test applies advanced genomic science to reveal the unique biology of a tumor in order to optimize cancer treatment decisions for each individual patient. The test is a multi-gene RT-PCR expression analysis developed to work in combination with prostate needle biopsies. It measures the expression of 12 cancer-related genes representing four biological pathways and 5 reference genes, which are then combined to calculate the Genomic Prostate Score (GPX). This biopsy-based score has been clinically validated as a predictor of aggressive prostate cancer. Three studies presented at the 110thAnnual Scientific Meeting of the American Urological Association this year showed this test improved risk assessment for patients and reduces cost of prostate cancer care. This test also is helping to examine further the biology and development of prostate cancer in African American men who are at a high risk for the disease.
- Prolaris & Genomic Prostate Score: The purpose of this score is to distinguish between aggressive cancers that need treatment and those that are slow growing and may need active surveillance. The Prolaris Score is a measure of how fast a prostate cancer tumor is growing after a biopsy has indicated its presence in the prostate gland. Biopsy tissue samples are used to determine a patient’s personal Prolaris Score. It measures how fast cancer cells in the tumor are dividing. Measuring a 46-gene expression signature, Prolaris also includes cell cycle progression genes selected based upon correlation with prostate tumor cell proliferation.
- ConfirmMDx: A genetic test rooted in the field of epigenetics, identifies key changes in gene activity for a negative biopsy or results showing high-grade PIN or ASAP. ConfirmMDx was developed to help reduce unnecessary repeat biopsies through its support of the negative predictive value (NPV). Clinical trials showed this test to be the most significant independent predictor for prostate cancer detection on repeat biopsy. A risk score for ConfirmMDx methylation-positive men was developed to increase the positive predictive value (PPV), which helps identify those with aggressive prostate cancer. This test combines these risk scores along with epigenetic profiling and strongly correlates with the detection of aggressive prostate cancer upon repeat biopsy.