Augmenting biopsy results with Prostatype Genomics

Overview by Mr Utsav Reddy
Consultant Urological Surgeon
Norfolk & Norwich University Hospital NHS Foundation Trust

What is Prostatype?

Prostatype is a test for those who have had a positive prostate biopsy result and who are now deciding between active surveillance and treatment.  The test determines the aggressiveness of the tumour and gives a score for the likelihood that the patient will die from their prostate cancer over the next 10 years if they don’t have any treatment.   This allows the doctor and patient to make a more informed decision about whether to proceed with treatment or not.  The test is performed on the prostate biopsy tissue at Cambridge Clinical Laboratories’ ISO15189 accredited laboratory in Cambridge.  The test checks the tumour for stem cell biomarkers which indicates how aggressive the tumour is.  

Who should use Prostatype?

For some men, prostate cancer grows rapidly and spreads quickly, and is therefore a very serious condition that requires aggressive and radical treatment. However, in many cases, the cancer grows slowly and the patient can be put onto active surveillance instead of treatment.  In fact, around 20% of men die with prostate cancer that they were not aware of, as it didn’t pose a threat to their life or show any symptoms.  Other prostate cancers start off slow-growing, but at later stages may cause pain or difficulties urinating as well as problems during sexual intercourse.  These may become more aggressive and pose threat to the patient’s life.   The current methods for diagnosing and assessing the aggressiveness of the prostate cancer are heavily dependent on visual assessment and human interpretation.  Therefore, sometimes it can be unclear whether to treat or not, and men in this situation will have different preferences on what they would like to do.   This leads to overtreatment in some cases, and undertreatment in other cases.  For men in this situation, there is a tricky decision to make – do they go ahead with treatment “just in case” the cancer does progress?  In these cases, Prostatype can be used to provide more information about the aggressiveness of the tumour, to help inform this decision. 

What does Prostatype tell you?

Using Prostatype, the consultant can gain more information on the likelihood that the prostate cancer will progress and become fatal.   Samples from the original biopsy material are analysed for three mRNA stem cell biomarkers – F3, IGFBP3 and VGLL3.  If these are present, they will be expressed across the whole tumour, so it doesn’t matter which part of the tumour is tested.  This information is analysed alongside the Gleason score, PSA, tumour stage and clinical data.  The result is a P-score.  The calculated P-score corresponds to a prostate cancer-specific mortality risk after 10 years, without treatment.   This reduces overtreatment and at the same time ensures that aggressive tumours are identified and treated quickly. 

Compared to the EAU standard guidelines, 35% of patients can be reclassified into active surveillance, while 65% of patients gain confirmation that treatment is the correct decision.  

How long do the results take?

10 working days.

How much does Prostatype cost?

£1500 + VAT.  Please note there may also be charges for preparation of biopsy material.

What are the advantages of Prostatype?

• The patient gets an objective second opinion on the aggressiveness of their tumour and their treatment plan
• The patient can be involved in the treatment choice
• The patient can be more certain that treatment they undergo is necessary
• Patients who are classified into active surveillance have reassurance that this is a safe and effective option