I am more optimistic that we will find a way to treat those who truly need to be treated and follow those unlikely to die from their disease.
The May 2015 issue of Urology Times discusses an abstract presented at the Genitourinary Cancers Symposium that reviews what the authors considered relevant articles on three commercially available prostate cancer biomarkers: Prolaris, Decipher, and Oncotype DX. The research, while raising questions about existing technology, also says a great deal about how far we’ve come.
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Criteria for the authors’ chosen articles included sample size, original validation studies, and to some extent, appropriate statistical evaluations. They reviewed 32 articles, and eight met their original criteria for review. After evaluating the assays’ predictive capabilities, their conclusion was that most of the studies were retrospective, had small sample sizes, and did not show large differences between clinical variables. They felt the future of these tests required further validation from prospective randomized clinical trials.
I agree with those conclusions. However, they must be viewed in the context of an exciting era in prostate cancer management that includes new genetic biomarkers, new imaging technology, and new minimally invasive approaches for definitive treatment.
In my practice, one of the fastest growing subpopulations consists of patients seeking active surveillance. I believe, as the literature shows, that we’ve been over-treating many low-risk and very low-risk prostate cancers, and likely undertreating high-risk prostate cancer. New imaging studies, such as MRI fusion techniques, and new genetic biomarkers will hopefully provide us better guidance as we try to decipher which patients can continue on surveillance and which ones might have a more aggressive disease that would likely threaten the host.
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My optimism in this area stems from the fact that the technology is moving very quickly. Just a few years ago, we had very few choices for genetic biomarkers, if any, and our imaging technology rarely provided additional information that might change our treatment. That has certainly changed in the last 5 years, making me more optimistic that we will find a way to treat those who truly need to be treated and follow those unlikely to die from their disease.
I applaud the authors for evaluating these studies and agree with their call for larger, prospectively designed trials to help validate the clinical utility of these markers. Technology continues to grow at an almost exponential pace. However, it’s always in our best interest and the best interest of our patients to evaluate new technology appropriately before its mass incorporation into our practices.
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