Monitor or treat?
Molecular risk stratification in newly diagnosed, localized prostate cancer.
Gleason 3+4, T2a, PSA 8. The guideline leaves several paths open here: watch, operate, irradiate, with or without androgen deprivation. The clinical parameters help with the choice only to a point, because they describe groups of men with a similar finding rather than the individual patient.
Hence the overtreatment this field is known for. When you do not know which tumour will stay harmless, you would rather treat. The price is incontinence and erectile dysfunction in men whose tumour might never have troubled them.
The reverse case occurs just as often: an unremarkable clinical picture, a biologically aggressive tumour. How fast a carcinoma proliferates cannot be read off the Gleason score.
The right moment is initial diagnosis, before treatment is settled — that is, when the question of watching or treating is genuinely open. This applies above all to low and intermediate risk, where the guidelines allow several paths side by side.
The test makes no sense in already metastatic disease, under ongoing therapy or for follow-up. It is prognostic and refers to the material from initial diagnosis; it is not a monitoring method. A rising PSA is its own reason for re-biopsy or imaging — it cannot be explained by a molecular score.
Unsure whether it fits your patient?
Call us. Five minutes on the phone do more than any list of indications — and if the test contributes nothing in the specific case, we will tell you so.