10 april 2019: Zie ook deze reviewstudie over diagnosetesten en technieken: 

https://kanker-actueel.nl/effectieve-diagnosetechnieken-voor-prostaatkanker-getoetst-in-reviewstudie-een-prima-hulp-voor-urologen-en-oncologen-hoe-prostaatkankerpatienten-te-behandelen-en-adviseren.html

19 mei 2017: Bron: American Urological Association (AUA) Annual Meeting 2017

Meer en meer komen er ook voor prostaatkanker aanvullende diagnostische testen zoals urinetesten en genentesten op de markt (zie in gerelateerde artikelen) die kunnen voorspellen of patiënten met een diagnose van operabele prostaatkanker nog verdere behandeling nodig hebben of dat zij kunnen volstaan met een wait-and-see beleid. Aan dit rijtje kan nu ook de GPS (Oncotype DX® Genomic Prostate Score Test) wel worden toegevoegd.

Op de American Urological Association (AUA) Annual Meeting 2017  werden overtuigende resultaten van de efficiëntie van de GPS test gepresenteerd. De GPS test voorspelde in een studie met grote zekerheid hoe groot de kans was dat patiënten met een diagnose van prostaatkanker later uitzaaiingen zouden ontwikkelen en / of zouden overlijden aan hun ziekte. Maar de belangrijkste conclusie was dat voor prostaatkankerpatiënten met een erg laag of laag of gemiddeld risico (Gleasonscore van 7 of minder) die bij de GPS test onder een score van 20 bleven zij verder geen behandeling nodig zouden hebben dan hoogstens een wait-and-see beleid.

(Red: Daarbij opgemerkt dat zover ik dat kan beoordelen geen rekening is gehouden met leefstijl en voedingspatroon van de patiënten dat m.i. in dit verband wel degelijk een rol kan spelen. Want leefstijl en voedingspatroon heeft echt invloed op de progressiviteit van prostaatkanker. Zie ook onze lijst specifiek bij prostaatkanker

Prostaatkanker GPS test

Kernpunten uit de GPS studie:

  • De resultaten vertoonden een breed scala van GPS scores binnen elke NCCN risicogroep en bevestigde dat de GPS score sterk gerelateerd was met een prostaatkanker-specifieke dood (P <.001) en metastasen - uitzaaiingen in een multivariabele analyse (P <.001)
  • Patiënten in deze studie met een diagnsoe van een zeer lage, lage of middelgrote vorm van prostaatkanker en een GPS-resultaat van minder dan 20 ontwikkelden geen tumor uitzaaiende ziekte of overleden aan prostaatkanker na een radicale prostatectomie.

In deze studie: Health Economic Impact and Prospective Clinical Utility of Oncotype DX® Genomic Prostate Score , gratis in te zien, wordt uitstekend beschreven hoe de GPS test werkt en welke resultaten er uitkomen.

Van deze studie hier het abstract met uitgebreide referentielijst:

Oncotype DX Genomic Prostate Score (GPS) test is a strong independent predictor of prostate cancer-specific death and disease progression at 10 years in men with localized prostate cancer across all clinical risk groups.

Rev Urol. 2016;18(3):123-132.

Health Economic Impact and Prospective Clinical Utility of Oncotype DX® Genomic Prostate Score.

Abstract

Prostate cancer (CaP) will be diagnosed in approximately 181,000 American men in 2016. Despite the high number of deaths from CaP in the United States, the disease has a protracted natural history and many men diagnosed with CaP will not die of the disease regardless of treatment. Unfortunately, identification of men with truly indolent/ nonaggressive CaP is challenging; limitations of conventional diagnostic modalities diminish the ability of physicians to accurately stage every case of CaP based on biopsy results alone. The resulting uncertainty in prognosis may prompt men with low-risk CaP to proceed to morbid and expensive treatments for an unclear survival benefit. Incorporation of the Genomic Prostate Score (GPS) as part of the decision algorithm for patients with National Comprehensive Cancer Network very low-risk and low-risk cancer led to a substantial increase in uptake of active surveillance and substantial cost savings. GPS provides physicians and patients with an additional tool in assessing personalized risk and helps guide individual decision making.

PMID:
27833462
PMCID:
PMC5102928
DOI:
10.3909/riu0725

Main Points

  • Identification of men with truly indolent/nonaggressive prostate cancer (CaP) is challenging; limitations of conventional diagnostic modalities diminish the ability of physicians to accurately stage every case of CaP based on biopsy results alone. The resulting uncertainty in prognosis may prompt men with low-risk CaP to proceed to morbid and expensive treatments for an unclear survival benefit.
  • The goal of the management of CaP is to screen, diagnose, and treat men based on the best available evidence for their individual risk and likelihood of benefit from treatment. With greater certainty regarding prognosis, men with CaP and their health care providers are able to make more confident decisions about the appropriateness of conservative management with active surveillance (AS) versus the advisability of immediate treatment.
  • Development of new techniques for identification of patients with truly indolent CaP is a public health priority. To be considered clinically useful, any new technique or intervention must demonstrate that it provides unique information not available with standard clinical parameters alone. One compelling approach for improving risk assessment in CaP is genomic testing. Genomic assays may be performed on serum, urine, or tissue samples to provide information about gene expression in various disease states.
  • Incorporation of the Genomic Prostate Score (GPS) as part of the decision algorithm for patients with very lowrisk and low-risk cancer led to substantial increase in uptake of AS and substantial cost savings. GPS provides physicians and patients with an additional tool in assessing personalized risk and helps guide individual decision making.

Conclusions

Incorporation of GPS as part of the decision algorithm for patients with NCCN very-low-risk and lowrisk cancer led to substantial increase in uptake of AS and substantial cost savings (average, $2286 per patient) for insurance carriers. Using the GPS list price of $4520, the $2286 savings represents a return on investment of over 50% ($2286/$4520) over 6 months. Further assessment of GPS in a larger pool of intermediate risk patients is needed to assess the potential impact on treatment planning. GPS provides physicians and patients with an additional tool in assessing personalized risk and helps guide individual decision making.

References

1. SEER Stat Fact Sheets: Prostate Cancer. National Cancer Institute website . http://seer.cancer.gov/statfacts/html/prost.html. Accessed August 20, 2016.
2. Xia J, Trock BJ, Cooperberg MR, et al. Prostate cancer mortality following active surveillance versus immediate radical prostatectomy. Clin Cancer Res. 2012;18:5471–5478. [PMC free article] [PubMed]
3. Yamamoto T, Musunuru B, Vesprini D, et al. Metastatic prostate cancer in men initially treated with active surveillance. J Urol. 2016;195:1409–1414. [PubMed]
4. Epstein JI, Feng Z, Trock BJ, Pierorazio PM. Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades. Eur Urol. 2012;61:1019–1024. [PMC free article] [PubMed]
5. Wilt TJ, Brawer MK, Jones KM, et al. Prostate Cancer Intervention versus Observation Trial (PIVOT) Study Group Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012;367:203213. [PMC free article] [PubMed]
6. Livingston CJ, Freeman RJ, Mohammad A, et al. Choosing Wisely® Task Force. Choosing Wisely® in Preventive Medicine: the American College of Preventive Medicine’s Top 5 List of Recommendations. Am J Prev Med. 2016;51:141–149. [PubMed]
7. Bhindi B, Mamdani M, Kulkarni GS, et al. Impact of the U.S. Preventive Services Task Force recommendations against prostate specific antigen screening on prostate biopsy and cancer detection rates. J Urol. 2015;193:1519–1524. [PubMed]
8. Martin NE, Mucci LA, Loda M, Depinho RA. Prognostic determinants in prostate cancer. Cancer J. 2011;17:429–437. [PMC free article] [PubMed]
9. Teutsch SM, Bradley LA, Palomaki GE, et al. EGAPP Working Group. The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Initiative: methods of the EGAPP Working Group. Genet Med. 2009;11:3–14. [PMC free article] [PubMed]
10. Bostrom PJ, Bjartell AS, Catto JW, et al. Genomic predictors of outcome in prostate cancer. Eur Urol. 2015;68:1033–1044. [PubMed]
11. Cullen J, Rosner IL, Brand TC, et al. A biopsy-based 17-gene genomic prostate score predicts recurrence after radical prostatectomy and adverse surgical pathology in a racially diverse population of men with clinically lowand intermediate-risk prostate cancer. Eur Urol. 2015;68:123–131. [PubMed]
12. Klein EA, Cooperberg MR, Magi-Galluzzi C, et al. A 17-gene assay to predict prostate cancer aggressiveness in the context of Gleason grade heterogeneity, tumor multifocality, and biopsy undersampling. Eur Urol. 2014;66:550–560. [PubMed]
13. Dall’ Era MA, Maddala T, Polychronopoulos L, et al. Utility of the Oncotype DX prostate cancer assay in clinical practice for treatment selection in men newly diagnosed with prostate cancer: a retrospective chart review analysis. Urology Practice. 2015;2:343–348.
14. Badani KK, Kemeter MJ, Febbo PG, et al. The impact of a biopsy based 17-gene genomic prostate score on treatment recommendations in men with newly diagnosed clinically prostate cancer who are candidates for active surveillance. Urology Practice. 2015;2:181–189.
15. Crawford DE, Gustavsen G, Brawer MB, et al. Evaluation of the economic impact of the CCP assay in localized prostate cancer. Presented at: Society of Urologic Oncology Annual Meeting. 2014. ; December 3-5, ; Bethesda, MD.
16. Shore ND, Kella N, Moran B, et al. Impact of the cell cycle progression test on physician and patient treatment selection for localized prostate cancer. J Urol. 2016;195:612–618. [PubMed]
17. Knezevic D, Goddard AD, Natraj N, et al. Analytical validation of the Oncotype DX prostate cancer assay a clinical RT-PCR assay optimized for prostate needle biopsies. BMC Genomics. 2013;14:690. [PMC free article] [PubMed]
18. Cooperberg MR, Carroll PR. Trends in management for patients with localized prostate cancer, 1990-2013. JAMA. 2015;314:80–82. [PubMed]
19. Vanderlaan BF, Broder MS, Chang EY, et al. Costeffectiveness of 21-gene assay in node-positive, earlystage breast cancer. Am J Manag Care. 2011;17:455–464. [PubMed]
20. Mariotto AB, Yabroff KR, Shao Y, et al. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103:117–128. [PMC free article] [PubMed]
21. Rizzo JA, Zyczynski TM, Chen J, et al. Lost labor productivity costs of prostate cancer to patients and their spouses: evidence from US National Survey Data. J Occup Environ Med. 2016;58:351–358. [PubMed]
22. Tosoian JJ, Loeb S, Epstein JI, et al. Active surveillance of prostate cancer: use, outcomes, imaging, and diagnostic tools. Am Soc Clin Oncol Educ Book. 2016;35:e235–e245. [PMC free article] [PubMed]
23. Hayes JH, Ollendorf DA, Pearson SD, et al. Active surveillance compared with initial treatment for men with low-risk prostate cancer: a decision analysis. JAMA. 2010;304:2373–2380. [PMC free article] [PubMed]
24. Johansson E, Steineck G, Holmberg L, et al. SPCG-4 Investigators. Long-term quality-of-life outcomes after radical prostatectomy or watchful waiting: the Scandinavian Prostate Cancer Group-4 randomised trial. Lancet Oncol. 2011;12:891–899. [PubMed]
25. Mohler JL, Armstrong AJ, Bahnson RR, et al. Prostate Cancer, Version 1.2016. J Natl Compr Canc Netw. 2016;14:19–30. [PubMed]

Articles from Reviews in Urology are provided here courtesy of MedReviews, LLC

Plaats een reactie ...

Reageer op "Genentest van Oncotype DX (GPS test) voorspelt of prostaatkankerpatienten behandeling nodig hebben of niet na operatie."


Gerelateerde artikelen
 

Gerelateerde artikelen

Urinetest met 18 genen ontdekt >> Prostaatkanker blijkt zich >> MRI van prostaat traceert >> Nieuwe diagnostische ontwikkelingen >> Combinatie van urinetest op >> Oncotype DX Genomic Prostate >> Aanwezigheid van bepaalde >> Prostaat-specifiek membraanantigeen >> Nieuwe richtlijnen bij diagnostiek >> finasteride kan prostaatkanker >>