Biomarkers to Predict Progression on Active Surveillance or Recurrence After Prostate Cancer Surgery

Andrew Siegel MD   8/17/2019

biomarker  (BY-oh-MAR-ker):  A biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease. A biomarker may be used to see how well the body responds to a treatment for a disease or condition. Also called molecular marker and signature molecule.

NCI Dictionary

Often of more important predictive value than prostate cancer histology (the appearance under the microscope) is the biology. Genomics is a biological field that studies the structure, function, and mapping of genomes (one’s DNA, including all genes) that can be helpful in revealing the biological potential of any given cancer. For example, 15% or so of low risk prostate cancers based upon Gleason score may have high risk features from the perspective of cancer genomics.


These biomarkers use genomic analysis of cancer tissue derived from the biopsy to help predict progressive disease that will require the need for active intervention in men on active surveillance.

OncotypeDx (genomic prostate score) This assay uses prostate cancer tissue to determine the expression of 17 genes, reporting the results using a 100-unit score. The higher the score, the greater the risk for aggressive prostate cancer. The test is useful for men with newly diagnosed prostate cancer to aid in making an informed decision regarding management, specifically to help guide who will benefit from active surveillance vs. who would benefit from surgery or radiation. It is beneficial for men with Gleason score 6 (3+3) and 7 (3+4).

The combination of Gleason score and genomic prostate score is the best predictor of potential prostate cancer aggression.  A genomic prostate score of < 20 is rarely associated with the potential for metastatic disease or death.

Note: The very helpful OncotypeDx test is used routinely by my urologic practice for all men with newly diagnosed prostate cancer whose biopsy show one or two foci of Gleason score 6 cancer and selectively for those with more than two biopsies showing Gleason score 6 and for those with Gleason score 7 (3+4).

Prolaris (cell cycle progression score) In addition to its use to predict recurrence after RALP, this assay is also useful to predict progression on active surveillance.  Prostate cancer tissue is used to calculate a score based upon RNA-expression levels of 31 genes to help predict cancer aggressiveness, the risk of a rising PSA and of death from prostate cancer.

ProMark This test using a quantitative analysis of 8 protein biomarkers.
from biopsy material to predict the risk of patients with Gleason score 6 (3+3) or Gleason score 7 (3+4) having aggressive prostate cancer.

PTEN/TMPRSS2:ERG  PTEN is a tumor suppressor gene that if deleted (not present) can indicate the potential for aggressive cancer. TMPRSS2 and ERG are genes that when found to be rearranged from their normal locations and in contact with each other can signify aggressive cancer. PTEN (phosphatase and tensin homolog) and ERG (ETS-related gene) mutations are two of the most common mutations found in prostate cancer and tend to occur in conjunction with one another. This molecular test can help predict prostate cancer aggressiveness in patients with Gleason score 6 (3+3) or 7 (3+4) as well as those with pre-cancerous conditions including HGPIN and ASAP.



Prolaris (cell cycle progression score) This assay uses prostate cancer tissue derived from prostatectomy to calculate a score based upon RNA-expression levels of 31 genes to help predict cancer aggressiveness, risk of a rising PSA and risk of death from prostate cancer.

Decipher (prostate cancer genomic classifier) This assay measures the expression levels of numerous RNA biomarkers in prostate cancer tissue to create a probability model to predict the risk of metastases within 5 years of RALP in patients with high risk prostate cancer.


Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.

The content of this entry is excerpted from his new book, PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

Prostate Cancer 20/20 on Apple iBooks

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health




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One Response to “Biomarkers to Predict Progression on Active Surveillance or Recurrence After Prostate Cancer Surgery”

  1. Futurology: What Lies Ahead in Prostate Cancer in 2020 and Beyond | Our Greatest Wealth Is Health Says:

    […] cancer behavior can be so variable, ranging from indolent and innocuous to aggressive and lethal.  Genetics-based biomarkers show great promise in improving the accuracy of assessing the potential of any given prostate […]

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