Daniel W. Lin, MD, and Eric A. Klein, MD, presented a special three-part Point-Counterpoint on “Point-Counterpoint: Oncotype Dx Genomic Prostate Score in Active Surveillance – Canary PASS Study” for the Grand Rounds in Urology audience in April, 2020 to discuss their differing viewpoints on the results of the Canary PASS cohort, and the extent to which those results support the ability of the Oncotype DX genomic prostate score (GPS) to measure adverse pathology in prostate cancer patients. Dr. Lin and Dr. Klein also discuss several follow-up questions related to the study and, more broadly, the future of prostate cancer treatment with E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology.
After viewing the three presentations, be sure to vote on which presenter’s view you support.
Point-Counterpoint – Pro: Oncotype Dx Genomic Prostate Score in Active Surveillance – Canary PASS Study – Summary:
Daniel W. Lin, MD, Pritt Family Endowed Chair for Prostate Cancer Research at the University of Washington School of Medicine, discusses recent results of Canary PASS (Prostate Active Surveillance Study), which looked at the ability of the Oncotype DX genomic prostate score (GPS) to predict adverse pathology (AP) in patients with low-risk prostate cancer treated with immediate surgery. The study demonstrated no significant link between GPS and adverse pathology in the cohort, specifically at surgery or during subsequent upgrading during biopsy when considered along with other clinical variables in the model.
Point-Counterpoint – Con: Oncotype Dx Genomic Prostate Score in Active Surveillance – Canary PASS Study – Summary:
Eric A. Klein, MD, Andrew C. Novick Distinguished Chair of the Glickman Urological and Kidney Institute and Professor of Surgery in the Lerner College of Medicine of the Cleveland Clinic, provides a counterpoint to the results discussed by Dr. Lin on the Canary PASS study. He focuses on how the results of the study are at odds with a recent study that showed a higher Oncotype DX genomic prostate score (GPS) is associated with an increase in adverse pathology (AP), as well as biochemical recurrence following radical prostatectomy. Dr. Klein further examines differences between the studies, including how the pathology was read, relatively small event rate, as well as the effects of focusing on a mostly low-risk population. He also reviews unpublished data on the original OncotypeDX cohort that may suggest a stronger connection between GPS score and AP.
Point-Counterpoint Q&A w/ Dr. Lin: Oncotype Dx Genomic Prostate Score in Active Surveillance – Canary PASS Study – Summary:
Daniel W. Lin, MD, and E. David Crawford, MD, discuss several follow-up questions from Dr. Lin’s presentation on the Canary PASS study. The two examine the limitations of the trial, as well as how well it represents the population of men going on active surveillance. They also cover the value of measuring PSA density in active surveillance as a predictor of adverse pathology, the value of active vs. inactive surveillance in prostate cancer treatment, as well as limitations and inconsistency in biopsies in active surveillance patients. They also discuss the potential future decrease of radical prostatectomies with the advent of focal therapies that have recently been approved or may be approved in the next five to ten years.
Point-Counterpoint Q&A w/ Dr. Klein: Oncotype Dx Genomic Prostate Score in Active Surveillance – Canary PASS Study – Summary:
Eric A. Klein, MD, and E. David Crawford, MD, discuss several items further to Dr. Klein’s counterpoint presentation on the Canary PASS study. They review the unpublished data Dr. Klein references in his presentation, how higher scores in genomic tests correlate with a higher incidence of genomic derangement, which further correlates with worse patient outcomes. They also explore the potential future value of the data from the Canary PASS trial, despite Dr. Klein’s misgivings about its conclusion.
How to cite: Lin, Daniel W. Klein, Eric A. “Point-Counterpoint: Genetic Prostate Score in Active Surveillance – The Canary Study” April, 2020. Accessed Jul 2024. https://grandroundsinurology.com/point-counterpoint-genetic-prostate-score-in-active-surveillance-the-canary-study/
About the Authors
Daniel W. Lin, MD
Dr. Lin is the Pritt Family Endowed Chair for Prostate Cancer Research and Professor and Chief of Urologic Oncology in the Department of Urology at the University of Washington School of Medicine in Seattle. He is also a urologist at the University of Washington Medical Center and the Seattle Cancer Care Alliance. He received his medical degree at Vanderbilt University Medical Center in Nashville, Tennessee, pursued a Fellowship in Urologic Oncology at Memorial Sloan-Kettering Cancer Center in New York City, and completed his internship and residency at the University of Washington School of Medicine. He serves on the National Comprehensive Cancer Network Guideline Panel for Renal and Testis Tumors, the Society of Urologic Oncology Executive Board, and the AUA Guideline Committees for Advanced Prostate Cancer and Renal Mass Follow-Up. Dr. Lin’s research interests include prostate chemoprevention and carcinogenesis, and his clinical research efforts are in active surveillance of prostate cancer and management of high-risk prostate cancer.
Eric A. Klein, MD
Eric A. Klein, MD is the Andrew C. Novick Distinguished Chair of the Glickman Urological and Kidney Institute and Professor of Surgery in the Lerner College of Medicine of the Cleveland Clinic. He was a cum laude graduate of the University of Pittsburgh School of Medicine and subsequently completed residency training in Urology at the Cleveland Clinic and a fellowship in Urologic Oncology at Memorial Sloan Kettering Cancer Center. He served as President of the Society of Urologic Oncology from 2009 – 2011. Dr. Klein’s clinical and research interests cover all stages of prostate cancer with a focus on genomics and clinical trials. He has served as Chairman of the Localized Prostate Cancer Committee of the Southwest Oncology Group and was the National Study Coordinator for the NCI-sponsored Selenium and Vitamin E Cancer Prevention Trial (SELECT). Dr. Klein has contributed more than 600 papers to the scientific literature, authored or edited eight books on urologic malignancies, and serves as the Editor-in-Chief of Urology. He has delivered more than 200 invited scientific lectures, including 13 named lectureships, and has served as a Visiting Professor at more than 60 institutions around the world. Dr. Klein was awarded the F. Mason Sones Innovation Award by the Cleveland Clinic in 2009, The Joe V. Meigs Award by the Society of Pelvic Surgeons in 2013 and 2015, was named the Kidney Foundation of Ohio’s Person of the Year in 2017, and has received five career achievement awards including a 2014 Presidential Citation from the American Urological Association, the 2014 Huggins Medal from the Society of Urologic Oncology, the 2015 Philip S. Hench Award from the University of Pittsburgh School of Medicine, the 2020 SUO Medal from the Society of Urologic Oncology, and the 2020 Richard D. Williams, MD Prostate Cancer Research Excellence Award from the Urology Care Foundation.
ABOUT THE AUTHOR
Researcher-physician E. David Crawford, MD, has devoted his career in medicine to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States.
He is currently a Professor of Urology and Jack A. Vickers Director of Prostate Research at the University of California, San Diego. Dr. Crawford received his medical degree from the University of Cincinnati and his postgraduate training included an internship and residency in urology at the Good Samaritan Hospital in Cincinnati. He subsequently completed a genitourinary cancer fellowship at the University of California Medical Center in Los Angeles.
Dr. Crawford is an internationally recognized expert in benign prostate hypertrophy, urologic cancers, and in particular, prostate cancer. He has conducted research in the treatment of advanced bladder cancer, metastatic adenocarcinoma of the prostate, hormone-refractory prostate cancer, and other areas of urological infections and malignancies. He has authored or coauthored over 810 scientific articles, has published seven textbooks, authored over 60 book chapters, and provided more than 2,200 educational talks for patients and physicians.
In an effort to raise public awareness about prostate health, Crawford in 1989 founded the Prostate Conditions Education Council (PCEC). The non-profit organization is comprised of a consortium of leading physicians, health educators, scientists, and men's health advocates. PCEC's advocacy for free or low-cost prostate screening has affected the lives of millions of American men. He currently chairs the PCEC.
Crawford is an active member of many national and international organizations, including the American Society of Clinical Oncology, the American Urological Association (AUA), and the American Association for the Advancement of Science. Within the AUA, he has been a member of the Committee to Study Urologic Research Funding and the prostate cancer clinical trials subcommittee. Crawford served on the board of governors, the scientific advisory board of the Southwest Oncology Group, and was chairman of the Genitourinary Cancer Committee for 27 years. This group is the largest clinical trials group in the world.
Crawford's involvement in the national prostate cancer arena has been widely recognized. He has received many honors and awards, including the CAP Cure Annual Award for Scientific Presentation in 1999 In 1997, he was presented with a 'Freddie Award" at the AMA International Health and Medical Film Competition for the program, ITV: The Cutting Edge Medical Report (Prostate Cancer: Understanding, Diagnosing, and Defeating), which Crawford hosted with special guest, retired General Norman Schwarzkopf.
Crawford again won a prestigious 'Freddie Award" 5 years ago... He is a member of Best Doctors of America and was named Healthcare Provider of the Year in the Denver Metro area by the Denver Business Journal.
He has been recognized as one of the Best Doctors of America for the past two decades and is recognized as one of the top 20 urologists in the country, for men, by Men’s Health Magazine. In 2018 he received the honor of being named the Distinguished Alumnus of the Year from the University of Cincinnati School of Medicine. In May of 2019, he received the Presidential citation from the American Urological Association recognizing for his “tireless role in genitourinary cancer research that has benefited countless urologic cancer patients.” He accepted the position of Editor in Chief of Grand Rounds in Urology in June of 2019. In 2021, he was the recipient of the Merle Stringer, M.D. annual award for excellence in medicine by the Florida State Medical Association.
