Understanding My Diagnosis
What is My Prostate Cancer Risk – and What Does it Mean?
Prostate cancer risk groups characterize the aggressiveness of a patient’s prostate cancer. According to the National Comprehensive Cancer Network (NCCN)®1, there are five risk categories—very low-risk, low-risk, intermediate-risk, high-risk, and very high-risk. NCCN risk levels are based on a man’s PSA level, Gleason score, clinical stage, number of positive cores, and the ratio of PSA to prostate size (i.e. PSA Density).
NCCN risk groups are critical guides to decision making. However, these risk groups are calculated based on clinical information that may be limited and/or may not accurately reflect the true nature of the prostate cancer. Additional testing can be important to help make a more accurate assessment of your prostate cancer risk level. You and your physician will put together a plan specific to your situation, based on your cancer risk level, results from other tests, and most importantly your personal beliefs and desires about how your prostate cancer should be managed.
- Stage T1C
- Gleason Score 6 or less
- No more than 2 cores of cancer
- <50% of core involved with cancer
- PSA less than 10ng/mL
- PSA density less than 0.15 ng/mL/mL
- Stage T1c or T2a
- PSA less than 10ng/mL
- Gleason Score 6 or less
- Stage T2b-T2c
- PSA 10-20 ng/mL
- Gleason Score 7
- Stage T3a
- PSA > 20 ng/mL
- Gleason Score 8 or higher
- Stage T3b or T4
- Primary Gleason 5 or >4 cores with Gleason 8 to 10
- Any stage with node involvement or distant metastasis
Genomic Tools for Assessing Your Individual Prostate Cancer
Genomic tests measure the expression of genes that might influence the aggressiveness of your prostate cancer. These tests are playing an increasingly important role in the management of prostate cancer at all phases, from diagnosis to management decisions to post-treatment decisions about supplemental treatment.
Information from genomic tests can help guide decisions about the best management for your specific disease. For example, genomic tests might be done after PSA screening to judge whether high PSA levels indicate cancer; after a biopsy to gauge whether or not the biopsy is an accurate reflection of the prostate tumor; or after surgery, to determine the likelihood of the cancer coming back.
Oncotype DX® Genomic Prostate Score
One such genomic test, the Oncotype DX Genomic Prostate Score (GPS), is intended for men recently diagnosed with very low-risk, low-risk, and select cases of intermediate-risk prostate cancer. The Oncotype DX GPS examines expression of specific genes in the prostate tumor to help predict the likelihood of high risk disease not detected through a biopsy2. The information provided by the Oncotype DX prostate cancer test is used in conjunction with the NCCN risk groups and may help you and your doctor determine the most appropriate management option for you based on the biology of your individual cancer.
Other Genomic Tests
There are other genomic tests available such as Decipher®3 and Prolaris®4 that assess tumor aggressiveness. Both Decipher and Prolaris are available for patients who have already gone through a radical prostatectomy (surgical removal of the prostate) and also in men who have had a biopsy that shows prostate cancer. These tests are validated as predictors of outcomes in prostate cancer but were not developed specifically for very low-risk, low-risk, and low intermediate-risk prostate cancer patients. Ask your physician about the best test option for you.
To Treat or Not to Treat?
Men diagnosed with prostate cancer have many different options available, and there is no one size fits all approach to prostate cancer.
Prostate cancer grows at different rates in different individuals. In fact, research suggests that many newly diagnosed prostate cancers are unlikely to spread during a man’s lifetime and therefore, may not require treatment. Ideally, these very low-risk, low-risk, and even some select intermediate risk cancers may be managed with active surveillance - strict, regular monitoring of the cancer by your healthcare team with a decision to treat if/when the cancer shows more aggressive features. Unfortunately, traditional clinical tests (biopsy, PSA, DRE) are not perfect predictors of how aggressive a given tumor will be. For some patients doctors may recommend a biopsy-based genomic test that can be used in conjunction with traditional measures to help determine the true biological aggressiveness of a cancer.
Aggressive prostate cancers that have a high risk of growing and spreading should be treated in a timely manner. Your doctor may suggest treatment including surgery (radical prostatectomy), radiation therapy, cryosurgery, hormonal therapy, chemotherapy, and emerging new drugs or investigational agents. For each man, the potential benefits versus risks and side effects of treatment should be considered. Understanding your unique diagnosis will help you and your healthcare team determine which options will work best for you.
Visit the Prostate Health Guide by Men’s Health Network to learn more about prostate cancer diagnostic tests.
1. NCCN and the NCCN Guidelines are registered trademarks of the National Comprehensive Cancer Network, Inc.
2. Cooperberg et al, AUA 2013, Abstract 2131
3. Decipher® is a registered trademark of GenomeDX
4. Prolaris® is a registered trademark of Myriad Genetic Laboratories, Inc.