Tests That Help You and Your Doctor Make Treatment Decisions
A prostate biopsy is currently the only sure way for your doctor to confirm whether you have prostate cancer. After you and your doctor decide to move forward with a prostate biopsy, you will have a follow-up clinic visit to talk about the results. If the biopsy shows prostate cancer, your doctor will look at several things, including:
- Your PSA level (a blood test that measures prostate-specific antigen, a protein made by the prostate),
- Your Gleason score (how aggressive the cancer looks under the microscope)
- Your overall health
Using this information, your doctor may recommend:
- Treatment, such as surgery to remove the prostate or radiation therapy, or
- Active surveillance (watching the cancer closely with regular tests and visits instead of treating it right away).
Sometimes, you and your doctor may want more detailed information about your cancer to help decide which plan is best for you. One option is to use special lab tests called biomarkers on the tissue from your biopsy. These tests can help show how aggressive your cancer is and how likely it is to come back after treatment.
Most of these biomarker tests are done on the small pieces of prostate tissue taken during your biopsy, and sometimes on the whole prostate that is removed during surgery. The biomarker tests listed below may help guide how closely you are monitored and which treatments you and your doctor choose after a biopsy. Not all these tests are listed in major treatment guidelines, and not every doctor will use them. We include them here to help you know what is available and what your treatment team might talk to you about:
Decipher
Decipher is a lab test that looks at the activity of certain genes in your prostate cancer tissue. This test helps estimate how likely your cancer is to spread or come back in the future.
Decipher can be done on tissue from your prostate biopsy and on the prostate that is removed during surgery (radical prostatectomy, an operation to remove the prostate gland). If you have Gleason 3+3 prostate cancer (often called low-risk cancer), a Decipher test can help show whether active surveillance is likely to be safe for you or if whether you are more likely to need treatment soon. If you have a small amount of Gleason 3+4 prostate cancer (sometimes called “favorable‑intermediate risk”), Decipher can also help you and your doctor decide whether close monitoring is still a good option or if it is safer to move ahead with treatment. Decipher can also help men who are planning their first treatment or who have already had surgery to remove the prostate.
For men who have had surgery, the test can give important information, such as:
- How likely it is that you might need radiation after surgery and how soon that might be needed.
- How likely it is that the cancer will spread outside the prostate area in the future if your PSA starts to rise after surgery. This rise if PSA after treatment is called biochemical recurrence.
- The chance that cancer will spread to other parts of your body (called metastases, when cancer cells travel and grow in other organs or bones) within 5 to 10 years after surgery if your cancer looked high-risk under the microscope.
ArteraAI Prostate Test
The ArteraAI Prostate Test uses computer technology (artificial intelligence) to analyze digital pictures of your biopsy tissue together with information like your PSA and Gleason score. This test helps estimate how your prostate cancer may behave over time and who might benefit most from certain treatments. There are several key scenarios where the ArteraAI Prostate Test can provide additional information:
- Helping to show whether adding short-term hormone therapy (also called androgen deprivation therapy, or ADT) to radiation is likely to give you extra benefit.
- Estimating your long-term outlook, including the chance that the cancer may spread to other parts of the body or cause serious problems in the future.
- Supporting decisions about active surveillance for men with low-risk or favorable- intermediate risk disease by estimating the chance of finding more aggressive cancer if the prostate were removed.
- After surgery, if your PSA begins to rise, helping estimate the chance that cancer will spread and whether adding hormone therapy to radiation might be helpful.
ConfirmMDx
ConfirmMDx is a test used when a man has had a biopsy that did not show cancer, but the doctor still has concerns. The test looks for subtle changes in the biopsy tissue called epigenetic changes (chemical "tags" on DNA that can turn genes on or off without changing the DNA sequence itself). These changes may suggest cancer could be present in parts of the prostate that were not sampled. This test helps your doctor decide whether you should have another biopsy.
Prolaris
Prolaris is a test that looks at how quickly your prostate cancer cells are growing and dividing. It combines information from many genes in the tumor to create a Prolaris Score that helps estimate how aggressive your cancer is. Prolaris can help you and your doctor decide whether active surveillance is a reasonable option or whether you are more likely to need treatment such as surgery or radiation.
Genomic Prostate Score (GPS) Test
The GPS test (formerly known as Oncotype DX Prostate) is a test that looks at the activity of certain genes in your prostate cancer to give a score from 0 to 100. After a biopsy, this score can help classify your cancer as lower or high risk. This test is performed on biopsy tissue, and the score helps estimate whether the cancer may be higher risk than it appears and how likely it is to grow or spread over time, supporting decisions about active surveillance versus treatment.
ProMark
ProMark is a test used in men with Gleason 3 + 3 or Gleason 3 + 4 prostate cancer on biopsy. It measures certain proteins in the cancer cells to estimate how aggressive the cancer is and gives a score between 0 and 1. This can help predict whether more serious cancer might be found if the prostate is removed.
| Biomarker | When to Consider this Biomarker? |
|---|---|
| Decipher Genomic Classifier | For men with intermediate-risk prostate cancer see how likely their cancer is to spread, and whether it is safer to choose active surveillance or move ahead with stronger treatment. |
| ArteraAI Prostate Test | For men with intermediate-risk prostate cancer to estimate long-term outlook and whether adding hormone therapy to radiation is likely to help. |
| ConfirmMDx | For men whose first biopsy did not show cancer, but there is still concern, to help decide if another biopsy is needed. |
| Prolaris | For men with low or favorable-intermediate risk prostate cancer to understand their long-term risk and decide between monitoring and treatment. |
| Genomic Prostate Score (GPS) test | For men with low- or favorable-intermediate risk prostate cancer to predict whether more aggressive cancer might be found at surgery and to better define risk. |
| ProMark | For men with low- or favorable-intermediate risk prostate cancer to use protein markers in the tumor to help decide whether active surveillance is a good option. |
Other Newer Tests
There are also newer and more experimental tests that may or may not be useful in your specific situation. Examples include:
- PTEN loss: loss of a gene called PTEN is linked with more aggressive prostate cancer and may help doctors talk with you about how strongly to treat your cancer, especially in more advanced.
- Germline testing: a blood or saliva test that looks for inherited gene changes. These results can sometimes guide targeted treatments in advanced prostate cancer and can also give information about your family’s risk, including your children.
- Somatic testing: looks for gene changes only in the cancer cells themselves and can also help doctors choose targeted treatments in advanced prostate cancer.
Researchers are also studying other tests that look at patterns of gene activity in the tumor or a combination of many inherited gene changes. These tests are still being studied and are not yet part of routine care.
Making Decisions About These Tests
The decision to use one or more of these biomarker tests after a biopsy or after surgery should be made together by you and your doctor. These tests are most helpful when they could change:
- How closely you are monitored or
- Which treatments you choose.
Not all of these tests are available at every hospital or clinic, and insurance coverage can vary. Before having a test, ask your care team about the cost and whether there might be any out-of-pocket expenses for you.