Prolaris for prostate cancer

[RadSki]

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Anyone have insights on the Prolaris test from Myriad Genetics? I have a 62 yo otherwise healthy gentleman with PSA 6, cT1c, Gleason 3+4=7, 3/12 cores, 40% maximal core involvement. Prolaris (ordered by urology) says "less aggressive" with 2% 10-year prostate cancer specific mortality risk. Anyone using this to drive decisions re: active surveillance vs. definitive treatment?

 

[Aralc]

If this were me, I would still undergo treatment, personally... with no other health conditions, his expected survival is close to 20 years, not 10.

But if he likes those odds (2% 10 yr PCa mortality risk), and is not willing to accept treatment complications, then sure, go for AS. He should also be aware that mortality risk is not the same as progression/ recurrence risk (i.e. what is the chance of him ultimately receiving definitive therapy? being on hormone therapy? developing metastatic disease?). Finally, he is at the higher end of what was included in the study, I think, based on his clinical parameters.

I say all this as someone who doesn't use the test, just based on a quick review of the information I found.

 

[Palex80]

Well, the guy is 62, so with low-score like that you can certainly advocate for AS. Even if the risk for progression within this person's lifetime is big and we all probably think, that he will need treatment at some point, why not?

5-8 more years of sexual intercourse ability don't sound that bad. Then, with 70 he can get his definitive treatment.

 

[Aralc]

probably personal decision based on how he views the various outcomes. Waiting and then being part of the 2% personally doesn't sound that appealing to me, but then, that's why I prefaced my statement with what I would personally do.