There are myriad prostate cancer screeners on the market, but a San Diego company’s test has an interesting spin: Researchers have found that the results of GenomeDx’s Decipher diagnostic shifts the way physicians recommend treatment for the disease, as seen in a recent Red Journal paper.
The company’s genomic test, which it’s commercializing now, predicts the probability of metastasis after surgery, and assesses how aggressive a tumor is. The test could help shape the opinion of urologists and radiation oncologists, who historically have butted heads when it comes to best practices in prostate cancer treatment, and nudging them closer to agreement.
About 230,000 men are diagnosed with prostate cancer each year, and roughly half decide to have surgery – the standard protocol to treat the disease. While it’s an effective treatment method, one common side effect is incontinence, which makes patients understandably reluctant. Prostate cancer is, after all, a slow-progressing disease, so in many instances a more benign form of treatment – or even none at all – is the best route of choice.
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A test is important, GenomeDx CEO Doug Dolginow said, because the tumor can be quite aggressive and even if it’s surgically removed, radiation’s required. However, at present there isn’t a very reliable method to screen out how aggressive a treatment regimen should be up front. The Decipher test is aimed at making this a bit more clear, he said.
There’s a strong specialty bias between urologists and radiation oncologists when it comes to treatment protocol, said Dr. Paul Nguyen, associate professor of radiation oncology at Harvard Medical School. He helped conduct the study.
“The two specialties very often disagree – urologists are more likely to discourage surgery and radiation, whereas radiation oncologists are more likely to treat you now,” Nguyen said.
That’s why it’s particularly compelling that showing docs the results from the Decipher test helped shape and even change their clinical opinions. When the clinicians saw a higher Decipher score, they’d prescribe further treatment, and if there was a low score, there would be less, Nguyen said. The Red Journal study found that patients with a high Decipher score benefited from early radiation, whereas those with low scores didn’t.
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The company says:
Using clinical information alone, observation was recommended in 42 percent of decisions made by urologists and only 23 percent by radiation oncologists. When the same cases were randomized and reviewed again with Decipher test results, treatment recommendations changed by 45 percent and 35 percent of each group, respectively.
“The bottom line: This reduces disagreements between the two specialties,” Nguyen said.
Nguyen finds that GenomeDx’s product “is doing a great job in the predictive space,” sorting out who’ll have a metastasis and who won’t. Dolginow said that a more nuanced understanding of what treatment protocol will work could reduce costs by about $7,000 on average per patient.
“Patients want these tests, and they’re driving a lot of this,” Nguyen said. “They’re calling me, asking how to get this test done.”
