A man has to make many decisions in his life. Over 1 million American men each year undergo prostate biopsy and 240,000 men face the decision about the right treatment for their own prostate cancer. But for many men, no treatment at all may be a good option. It’s called “active surveillance”-a fancy term for what used to be called “watch and wait.” The “active” part is men now taking responsibility, in a major way, for their own prostate health.
Whether or not to treat prostate cancer is a hard decision. There are lots of options-so many, I think, that men can get overwhelmed by the choices. But the more we learn about the biology of prostate cancer, the more we recognize, as cancer specialists, that not all men with prostate cancer need to be treated with surgery or radiation.
The New Oncotype DX Prostate Cancer Test Helps Men with Early Stage Prostate Cancer
Each and every week, I face newly diagnosed men with prostate cancer who have a lot of questions. How fast is my prostate cancer growing? How aggressive is my cancer? How can you be sure that the biopsies reflect all the cancer in my prostate? Is my prostate cancer localized or spreading? What are my options? What are the side effects? Is radiation or surgery the only answer? Can I watch and wait?
As prostate cancer patients and prostate cancer specialists, it is only human to want a single test to have all the answers. It’s just not that simple. But the results of the Oncotype DX prostate cancer test go a long way in helping us to answer whether men with low risk prostate cancer need immediate treatment or not. The results of a major study were presented at the 2015 American Urologic Association meeting held in New Orleans this spring.
This first large-scale study of 4,000 prostate cancer patients was analyzed with the Oncotype DX prostate cancer test showed positive results. Of those men with so-called “low risk” prostate cancer, 36.9% had results indicating “very low risk,” while 11.3% had worse disease with higher risk prostate cancer. So about one third of those men with low risk disease by standard criteria were felt appropriate for a watch and wait approach.
So What’s a Man with Early-Stage Prostate Cancer to Do?
Clearly, the Oncotype DX Prostate Cancer test is not the one and only test we all hoped for; but I think it‘s another important tool for prostate cancer specialists to be aware of.
My recommendations for watch and wait approach are the following:
- PSA less than 10 ng/mL
- PSA doubling time of greater than 12 months
- Gleason score 6 or lower and no perineural invasion
- No more than 2 positive biopsies
- No prostate nodule on digital rectal exam
- No family history of prostate cancer
- No extracapsular extension on MR scan
- A low Oncotype DX prostate cancer score
If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1. I guarantee that I will see you within 1-3 days of your call.