How are the “same” cancers treated differently? Not all gleason6,7, or 8+ can be treated equally. How do we individualize care with the diagnostic tools available to us, when patients present with similar clinicopathologic characteristics? Using all the tools currently available, clinicians can gather more information about the case at each step of the way.

❖ Elevated PSA: red flag to get more testing done and determine what the cause of this elevation might be. Each one of these tests can give us more info and may or may not lead to biopsy of the tissue

➢ PHI test

➢ 4K score

➢ PCA3 test

➢ Prostate MRI

❖ Prostate Biopsy: if biopsy is positive, we are left with the question of whether, or not, and how to treat the prostate cancer. Different types of genetic testing can help give us more information as to the growth rate, aggressiveness and risk of morbidity.

➢ Prolaris

➢ OncotypeDx

➢ Prostavysion

➢ Testing for hereditary PCa, and genes like BRCA to evaluate risk factors

❖ Surgery: if surgery is recommended, prostate gland can be analyzed to evaluate likelihood of metastasis and/or biochemical recurrence.

➢ Genome Dx / Decipher test

➢ PSA test → important to follow trend and how soon after surgery it increases

❖ Radiation: used as secondary treatment for those cases that face biochemical recurrence post-prostatectomy