The Biopsy is Positive, What Next?
The overdiagnosis and overtreatment of indolent cancers has received a lot of scrutiny recently. As a result additional tests may be performed to help assess the aggressiveness of the tumor and decide whether or not treatment is indicated. Different types of genetic testing may be performed to give information on the tumor’s growth rate, aggressiveness and risk of morbidity. Such tests include Prolaris, OncotypeDX and ProstaVysion. Many more tests are in development.
The pathology report, imaging studies and physical exam are all used to assign a stage. Stage is the extent of tumor within the prostate and whether tumor extends to other structures such as the seminal vesicles, lymph nodes or distant sites (metastases).
The genetics of prostate cancer are being deciphered. It is now known that one of the most important genes in breast cancer is also involved in prostate cancer, the BRCA gene. Genetic testing for this gene and others may be appropriate in high risk patients. In fact, the same treatments that have been shown effective in other BRCA driven cancers shows promise in prostate cancer. Recent studies have found that genetic testing may help predict the risk of developing prostate cancer.
This deep understanding of the genetic basis of cancer and harnessing that knowledge to predict cancer or target a patient’s unique tumor characteristics is termed personalized or precision medicine. It has dramatically changed our approach to cancer care. Pathologists have been instrumental in this process, allowing the selection of the right drug for the patient. Many such targets were recently discovered for advanced prostate cancer.
As a pathologist and a member of the care team, I know the strongest weapon in the fight against cancer is an educated patient. Be proactive in your care. Get a copy of your pathology report. Ask about the pathologist involved in your care. We want to help you.