Somatic/genomic tissue tests? Dr. Morgan says to keep it simple--testing is not for all of us
By Howard Wolinsky
Dr. Todd Morgan, the genomics expert and chief of urologic surgery at the University of Michigan in Ann Arbor (Go Blue!) helped me clarify some questions I had on genomic or somatic testing at a webinar sponsored by AnCan on Aug. 31,
And I think his responses can help you.
Some of us have multiple genomic or somatic tests, and some of us have had just one or none. (I’ve never been tested myself except as part of a study—I assume all is well since no ione ever called me.)
Somatic studies on our core test the genetic or genomic makeup of our cancer prostate lesions. Our cancers have their own DNA. This is different from our inherited or germline testing of the genes we get from our parents.
Again, do we need to take multiple somatic tests--the Decipher tests, the Prolaris tests and Oncotype Dx.
Morgan says NO.
(Dr. Todd Morgan, chief urological surgery, Michigan Medicine.)
He told me: “No, absolutely not. … the field is confusing, and it's hard for us to communicate clearly, but there is no difference between one test and the other. The scores are pretty darn highly correlated from one test to the next. There are differences, but the scores are pretty well correlated. And if you get two tests, and one's higher and the other lower, you would have no idea what to do with the information.”
So guys, don’t feel compelled to undergo multiple genomic tests, which can cost $2k or more at a crack, retail.
Also, Morgan advises those of us with low-risk prostate not to get one of these tests, just for the sake of having one.
He uses somatic testing at “an inflection point, where we need to make a decision about something.
“There's a real tendency amongst everybody—patients, providers, you name it-- to say it's easier just to have the tissue sent off and get some more information, but what is that going to tell us, right? If somebody has been on surveillance for three years, and they've had three biopsies at all show low-volume Gleason 6 cancer, and then all of a sudden, they get a Prolaris test and it shows that they're high risk on that test. Should that impact decisions? I don't know, what do you think?” he said. “I would say, No.”
Morgan said he reserves somatic tests for “a patient who's in a gray area decision zone. And there are many, right? There are many patients who have higher-volume Gleason 6 disease, lower volume Gleason 3+4, any patient with favorable, intermediate prostate cancer might be considering active surveillance.”
Read that previous sentence again.
So somatic testing really isn’t really for those of us with low-risk prostate cancer.
There is a belief among some patients and doctors that somatic tests tend to be pessimistic in general, and the Decipher test is the most pessimistic. (Check out Mark Scholtz, MD, of Prostate Cancer Research Institute:
But Morgan rejected this, saying these tests have just minor differences.
Morgan is heading up a study called “G Major,” in which the leading somatic tests will be used in “grey zone” clinical settings. He said the additional data point to be considered along with PSAs, MRIs and biopsies.
He said the purpose of G Major from the MUSIC group in Michigan “is to understand genomic testing writ large, so the big picture for the field. Is genomic testing helpful for patients with early-stage prostate cancer? It is not to tell us if Decipher is better than Prolaris, or Prolaris better than Decipher, or Oncotype DX/Genomic Prostate Score (GPS) , the study is not going to be powered to tell us which one is better than the other, nor do we think that's a really super important question because there's so much data that all three of these tests work really well.”
To hear the full program, go to: https://ancan.org/webinar-how-and-why-prostate-cancer-genomic-tests-work/
Find out why patients on AS owe Dr. Morgan a thanks:
Humor & the Prostate—The Gleasons: Putting Glee Into The Gleason Score
By Howard Wolinsky
Entries are trickling into the first humor contest on prostate conditions—from prostate cancer through BPH and on to prostatitis.
We call the competition, The Gleasons: Putting Glee Into Gleason Scores.”
The contest, started by Jim-Bob Williams, a therapeutic humorist, and me, is open to doctors and patients alike. Send your quips, cartoons, one-liners, shaggy dogs, and blue humor ti howard.wolinsky@gmail.com The deadline is Sept. 1.
A distinguished panel will announce the winners later in Prostate Cancer Awareness Month.
We’re adding a professional category. Comedians like to do observational humor on their first prostate exams. Nominate your favorites.
Check out these bits from:
Hurricane:
John Mulaney
Andrew Santino
Marc Maron:
For more:
BTW, here’s Dr. Brian Helfand, my urologist—about to give me the finger. Why not submit a caption?
(Dr. Laurence Klotz receiving the first Chodak Award from ASPI in 2022.)
Join Dr. Laurence Klotz in a webinar on focal therapy on Aug. 31
Talking about prostate entertainment.
Famed urologist Dr. Laurence Klotz is a jazzman.
He even considered a career as a jazz pianist. His teacher cured him of that notion by inviting him to a jazz piano performance in a Chinese restaurant in Toronto.
Klotz was shocked to see restaurant patrons ignore his teacher and talk right over the performance.
So he took another path, becoming a urologist, one of the “fathers” of Active Surveillance. I wonder if all those finger exercises in tickling the ivories gave Klotz an advantage in surgery and in tickling the prostate in DREs.
He and his colleagues helped slow, if not stop, the onslaught of unnecessary surgery and its horrible side effects.
Klotz also is a pioneer in focal therapy, methods to remove lesions without performing radical prostatectomies.
He will share his experience at the University of Toronto in a free webinar at 8-9:30 p.m. August 31 entitled, "Is focal therapy right for your prostate cancer?" Register at https://attendee.gotowebinar.com/register/1495697985984134744
You should walk away—or stream away— from the program with an understanding of whether you are a candidate—or not—for focal therapy.
Focal therapy offers middle-ground therapy for men with localized prostate cancer. It uses ablation, or tissue destruction, to target the area that contains the index lesion. Men who have focal therapy will continue to be monitored after treatment.
This program is aimed at the newly diagnosed who are considering options and those who are considering leaving Active Surveillance.
If you can’t make it, register and you’ll automatically get the link to the video
Meanwhile, Dr. K., can you play “Misty” for me?
You may be unable to make song requests at the webinar—which Klot accepts at major urology meetings—but you can ask him questions. If you have questions in advance, send them to joeg@ancan.org.
(Interesting profile on Klotz here.)