A recent Mayo Clinic study suggests that needle biopsy procedures may miss higher-risk cancer that increases the risk of disease progression. Investigators recommend that men diagnosed with low-risk cancer should pursue additional testing for these chromosomal alterations.
“We have discovered new molecular markers that can help guide men in their decisions about the course of their prostate cancer care”, explained lead author George Vasmatzis, Ph.D., co-director of the Center for Individualized Medicine Biomarker Discovery Program. “Overtreatment has been an issue for the group of men that our study targets. We found that the presence of genetic alterations in low-risk cancer can help men decide whether treatment or active surveillance is right for them”.
At the moment, prostate cancer is evaluated according to the Gleason patterns and score that indicate grade. A pattern 3 is considered to be low-risk, while patterns 4 and 5 carry a higher risk of aggressive behavior.
Men suffering from prostate cancer at a Gleason pattern 3 may chose active surveillance. In this case, their condition is closely monitored and they undergo blood tests and needle biopsies, as necessary. With prostate cancer generally having a slow development, patients may prefer this approach as it allows them to avoid the harsh effects of chemotherapy or possible complications from surgery.
Those who do not display these alterations in their cancers have a low risk of harboring aggressive disease, and might now choose a more passive approach. Alternatively, a low risk patient showing these alterations has a higher risk that their cancer may progress, and might opt for active treatment.
Testing was done with a high-tech genomic tool known as mate-pair sequencing. Among the 126 samples, researchers found five genes that are more commonly altered in Gleason patterns 4 and 5 and in patterns 3 associated with increased risk.
“The needle biopsy procedure samples only a small portion of the tumor. It is not uncommon that a man with a Gleason pattern 3 on needle biopsy specimen harbors a higher-grade cancer next to the pattern 3 that was missed by the procedure”, noted John Cheville, M.D, co-author of the study.
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