Post by Admin on Sept 24, 2016 16:14:35 GMT -8
First I'd like to direct you to an article written by my friend Mike Scott.
"Just how accurate are current genetic tests in the diagnosis and prognosis of prostate cancer?"
In the Wei et al paper, multiple samples from 4 consecutive patients were compared with DNA and RNA sequencing. And it was clear that each sample of adenocarcinoma had significant genetic differences. Thus when you decide to use any of todays available genetic test, i.e. Polaris, Decipher, OncoDX, are probably not useful in deciding what course of action to take with each case of prostate cancer. Is it worth paying high dollars to get these tests done? Maybe and maybe not yet. What is clear is that prostate cancer in it's early form are made up a several genetic signatures. Thus the disease is typically heterogeneous.
But what about metastatic prostate cancer?
Dr. Pete Nelson recently posted this article that says maybe not once the disease becomes fast and aggressive. When comparing these genetic markers between patients they are not the same but...Nelson describes that when comparing several metastatic lesions within a single patient that tumors seem to maintain a consistent genetic pattern. Metastatic prostate cancer can be and looks homogeneous in nature. Thus again perhaps paving a road for a customized treatment to be designed. Of course we are years away from doing so...
Dr Nicholas Vogelzang describes prostate cancer as two disease. He likes to use the "Turtles and Eagles" analogy. Slow moving disease being the turtles because it does not travel far quickly. And he describes the metastatic version as eagles because eagles can move quickly and strike far away. He also states that this would indicate that the eagles are more complex genetically. But I would submit it might actually be the opposite. The turtles are more complex because of their heterogeneity. And the eagles are in fact a more consistent homogeneous variety.
One day we will understand this all better. But it is fascinating to ponder both perspectives. So which is it? Probably both!!!
"Just how accurate are current genetic tests in the diagnosis and prognosis of prostate cancer?"
In the Wei et al paper, multiple samples from 4 consecutive patients were compared with DNA and RNA sequencing. And it was clear that each sample of adenocarcinoma had significant genetic differences. Thus when you decide to use any of todays available genetic test, i.e. Polaris, Decipher, OncoDX, are probably not useful in deciding what course of action to take with each case of prostate cancer. Is it worth paying high dollars to get these tests done? Maybe and maybe not yet. What is clear is that prostate cancer in it's early form are made up a several genetic signatures. Thus the disease is typically heterogeneous.
But what about metastatic prostate cancer?
Dr. Pete Nelson recently posted this article that says maybe not once the disease becomes fast and aggressive. When comparing these genetic markers between patients they are not the same but...Nelson describes that when comparing several metastatic lesions within a single patient that tumors seem to maintain a consistent genetic pattern. Metastatic prostate cancer can be and looks homogeneous in nature. Thus again perhaps paving a road for a customized treatment to be designed. Of course we are years away from doing so...
Dr Nicholas Vogelzang describes prostate cancer as two disease. He likes to use the "Turtles and Eagles" analogy. Slow moving disease being the turtles because it does not travel far quickly. And he describes the metastatic version as eagles because eagles can move quickly and strike far away. He also states that this would indicate that the eagles are more complex genetically. But I would submit it might actually be the opposite. The turtles are more complex because of their heterogeneity. And the eagles are in fact a more consistent homogeneous variety.
One day we will understand this all better. But it is fascinating to ponder both perspectives. So which is it? Probably both!!!
