Oncotype DX GPS and mpMRI yin and yang

Maximize your understanding of tumor biology and geography by using the Oncotype DX® GPS™ assay with mpMRI for patients with Gleason scores 3+3 and 3+4.

Use Oncotype DX GPS assay to determine:

  • If the tumor is biologically aggressive
  • If a patient is an Active Surveillance or immediate treatment candidate

Use mpMRI to determine:

  • If a patient needs a biopsy
  • Areas of interest to sample

The GPS result independently identifies likelihood of upgrade on subsequent biopsy1

In a UCSF study of patients on Active Surveillance who received both the GPS assay and mpMRI, only the GPS assay was independently associated with biopsy upgrade.

In the setting of mpMRI-guided biopsies, the GPS result is a strong independent predictor of adverse pathology2

The predictive values of the GPS result and other clinical factors* were analyzed in patients who received mpMRI-guided and systematic biopsy within 6 months of radical prostatectomy:

Biopsy GS +
GPS result

AUC 0.79
=
Biopsy GS + GPS result + mpMRI
AUC 0.79
Incorporating mpMRI did not improve predictive value
 

Drs. Brian Helfand (NorthShore Medical Group) and Paul Sieber (Penn Medicine Lancaster General Hospital) discuss how they use mpMRI and the GPS assay complementarily in their practices.

Use mpMRI and the Oncotype DX GPS assay together for additional clarity

The Oncotype DX GPS assay complements mpMRI usage

mpMRI has the potential to find aggressive disease and reduce the need for invasive biopsies. However, limitations do exist.

How the GPS assay adds value

Limitations of mpMRI

Objective and highly reproducible molecular data about the patient’s tumor biology Subjective intraobserver/interobserver variability in interpretation6,7
  • Designed to be predictive in the context of tumor heterogeneity, multifocality, and undersampling of GS 3+3 and 3+4 prostate cancer3,4
  • Genes were chosen based on their consistent correlation with tumor aggressiveness and expression in biopsy samples as small as 1 mm3,4
  • Validated to predict risk of adverse pathology4,5
  • Misses up to 75% of small (<0.5 cc) Gleason 4+3 tumors8
  • Dependent on tissue examined and location of tumor9,10
  • Potentially underestimates tumor volume10
  • Variable sensitivity for extracapsular extension2,11
Performed on tissue from initial biopsy Additional biopsies may be needed
Easily ordered through the Genomic Health portal May have limited availability
REFERENCES
  1. Kornberg et al. J Urol. 2019.
  2. Salmasi et al. J Urol. 2018.
  3. Knezevic et al. BMC Genomics. 2013.
  4. Klein et al. Eur Urol. 2014.
  5. Cullen et al. Eur Urol. 2015.
  6. Muller et al. Radiology. 2015.
  7. Greer et al. J Mag Reson Imaging. 2017.
  8. Vargas et al. Eur Radiol. 2016.
  9. Bojorquez et al. PLoS One. 2019.
  10. American College of Radiology. PI-RADS v2.1. 2019.
  11. de Rooij et al. Eur Urol. 2016.
  12. Van Den Eeden et al. Eur Urol. 2017.
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