Genetics 101
What are the three types of cancer?
Hereditary, Familial, and Sporadic
What type of sample is Prolaris Biopsy Genomic Biomarker Ran on?
What is the standard turnaround time it takes for Prolaris to report?
2 Weeks
How many cores is taken in a standard prostate biopsy?
12
What does ADT stand for?
Androgen Deprivation Therapy
Somatic mutations are?
are only present in certain cells and may not be present in other cells of the body
How many genes does the prolaris test look at and what types of genes are they?
31 CCP and 15 housekeeping genes
What is the AS threshold set at? What study validated it?
3.2% risk of DSM over 10 years with conservative management. Lin AS Threshold
What is an important antigen that the prostate produces?
PSA (Prostate Specific Antigen)
What is the preferred treatment option for a NCCN Low Risk Patient?
AS
What are the three red flags for hereditary cancer?
Young, Rare, Multiple
What are the names of the 2 key validation studies in conservatively managed men?
Cuzick 1 and 2
What study validated the AS Threshold? What Studies validated the MM Thresholds?
8.8% Risk of mets over 10 years. Tward 1 and Tward 2
What does the AUA stand for?
American Urologic Association
What was the Schreiber study and what was one key take away?
Comparing Biopsy Gleason score to final path. Only agree 55% of the time
A Mutation is?
A change from the normal DNA sequence
In the Tward 1 Study what definitive therapy or therapies did the cohort of patients receive?
RT or RP +/- Multi-Modal Therapy
What was one key takeaway from Cuzick 1
Prolaris was 2x more prognostic than PSA and Gleason.
Prolaris was able to better stratify an inidivuals mortality risk
Conservatively managed patients
True or False - A Gleason score of 3+4=7 is the same as a Gleason score of 4+3=7
False
What was the Epstein Study looking at and what was one of the main takeaways?
10 top GU pathologists looking at standard slides, only agreed 66% of the time.
Bonus : Patient Case E!
What year was Myriad Genetics founded?
1991
What are the three main endpoints of the Prolaris result? What is the fourth feature of the test?
10-year DSM with Conservative management
10-year risk of Mets with Surgery or RT
10-year Risk of Mets with RT + ADT / RP + intensified therapy per the guidelines
ARR - benefit of adding ADT to RT
In the Tward 2 study men treated with RT (radiation therapy) alone who had a CCR above the threshold of 2.112 had what predicted risk of metastasis compared to those below the threshold?
6 Fold Risk
What are the five key clinical and pathologic features of the work up of prostate cancer?
Age, Percent cores positive, Gleason score, Pre-biopsy PSA, and Tumor Stage (DRE)
What NCCN Risk Categories does Medicare cover for Prolaris testing?
All Risk Categories