Aaron E. Katz, MD, FACS, professor, Department of Urology, NYU Long Island School of Medicine, chairman, Department of Urology, Winthrop Hospital, NYU Langone Health’s Perlmutter Cancer Center, discusses redefining risk stratification for men with prostate cancer.

Historically, risk stratification for men with prostate cancer has been based on patients’ Gleason grading system score, prostate specific antigen level, number of cores, and rectal examination, says Katz. 

However, the field is moving toward an era of molecular stratification, Katz explains. This strategy could expand to other ​solid tumor types, such as breast cancer, ovarian cancer, and colon cancer, as well as hematologic malignancies ​like leukemia and lymphoma, Katz concludes.

Videos

Aaron E. Katz, MD, FACS, discusses redefining risk stratification for men with prostate cancer.

Dr. Katz on Redefining Risk Stratification in Prostate Cancer

Aaron E. Katz, MD, FACS, professor, Department of Urology, NYU Long Island School of Medicine, chairman, Department of Urology, Winthrop Hospital, NYU Langone Health’s Perlmutter Cancer Center, discusses the Oncotype DX Genomic Prostate Score (GPS) assay in patients with prostate cancer.

The Oncotype DX Genomic Prostate Score (GPS) assay has been validated by several institutions and is now part of the National Comprehensive Cancer Network guidelines to help stratify which patients should be on active surveillance programs, says Katz. This genomic test was developed to analyze the 21 genes expressed in the prostate. Some of these genes are regulated by hormones, while others are proliferated, adds Katz.

The idea behind the functionality of this is assay is incredible, according to Katz. Rather than looking under the microscope and seeing the cellular architecture and describing the Gleason grading system, which has classically been used for many years, Oncotype DX offers an added feature, says Katz. By isolating just the cancer cells and extracting the DNA, a reverse transcription-polymerase chain reaction (RTCPR) can be done to better analyze the expression of specific genes and a new GPS can be developed, explains Katz.

This score can provide information on the individualized, specific expression within cancer cells to determine whether they are more or less aggressive than what we had initially thought with examining the classic Gleason grade, adds Katz.

This shows investigators that, even if cancer types fall under a similar category, they may not all behave in the same way, concludes Katz.

Aaron E. Katz, MD, FACS, discusses the Oncotype DX Genomic Prostate Score assay in patients with prostate cancer.

Dr. Katz on the Oncotype DX GPS Assay in Prostate Cancer

Aaron E. Katz, MD, FACS, professor, Department of Urology, NYU Long Island School of Medicine, chairman, Department of Urology, Winthrop Hospital, NYU Langone Health’s Perlmutter Cancer Center, discusses reclassifying patients with prostate cancer by utilizing the 17-gene Oncotype DX Genomic Prostate Score (GPS).

In a study, investigators utilized the 17-gene RT-PCR Prostate Assay to look at the clinical experience of 33,000 patients with clinically low-risk prostate cancer in the United States, says Katz. In this research, investigators were able to redefine the risk assessment in these patients.

Results showed was that men who were defined to be low- and intermediate-risk via the National Comprehensive Cancer Center guidelines were recategorized based upon the new genomic score. Those in the low-risk group were reclassified in 62% of cases and those in the intermediate-risk group were reclassified in 34% of cases, says Katz.

It is important to understand that some of the patients who are considered to be low risk may actually harbor more aggressive disease, concludes Katz.

Aaron E. Katz, MD, FACS, discusses re-classifying low-risk prostate scores with the 17-gene Oncotype DX Genomic Prostate Score.

Dr. Katz on Redefining Risk Assessment in Prostate Cancer With 17-Gene Oncotype DX GPS

Aaron E. Katz, MD, FACS, professor, Department of Urology, NYU Long Island School of Medicine, chairman, Department of Urology, Winthrop Hospital, NYU Langone Health’s Perlmutter Cancer Center, discusses strategies for determining low-risk prostate cancer.

Patients with low-risk prostate cancer can be monitored with active surveillance rather than receive up-front treatment.

Patients who do not have multi-core or primary pattern 4 biopsies may have low-risk disease, says Katz.

Additionally, biochemical assays may factor into risk stratification as patients with a prostate-specific antigen (PSA) of less than 10 are eligible for active surveillance, explains Katz.

Some patients with PSA scores of greater than 10 can receive active surveillance because risk is also stratified by prostate volume, says Katz. MRI can often identify lesions in the prostate based on PI-RADS [Prostate Imaging Reporting & Data System] score and the volume of prostate.

From there, a patient’s PSA density can further stratify their disease. Patients with lower PSA density are more likely to derive a favorable response from active surveillance, concludes Katz.

Articles

Aaron E. Katz, MD, FACS, discusses strategies for determining low-risk prostate cancer.

Aaron E. Katz, MD, FACS

Articles

Dr. Katz on Redefining Risk Stratification in Prostate Cancer

Dr. Katz on the Oncotype DX GPS Assay in Prostate Cancer

Dr. Katz on Redefining Risk Assessment in Prostate Cancer With 17-Gene Oncotype DX GPS

Dr. Katz on Determining Low-Risk Disease in Prostate Cancer