Prostate Cancer Management: A Guide for Patients and Caregivers Oncotype DX® Prostate Cancer Assay: The Role of Genomics In Your Decision-Making Is Active Surveillance Right For You? Prostate Cancer Management: A Guide for Patients and Caregivers GHI40101_0914 1

Topics we will address today… Prostate Cancer Basics Understanding Your Treatment Options Active Surveillance Oncotype DX® Test Overview Additional Resources for Patients Next Steps

Prostate cancer basics What you and your loved ones need to know: MOST SOME 1 in 6 Prostate Cancer Facts You & Your Loved Ones Need to Know https://www.youtube.com/watch?v=I6kezDpwgyU Reference: Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014 Jan-Feb;64(1):9-29. Patient Education Brochure men will be diagnosed with prostate cancer during their lifetime prostate cancers are aggressive and higher risk prostate cancers are not aggressive and lower risk (favorable pathology)

Low-risk prostate cancer is often over-treated 90% OF MEN RECEIVE IMMEDIATE TREATMENT YET ONLY 3% ARE AT RISK OF PROGRESSION & DEATH Reference: Patient Education Brochure Prostate Sales Aide Grey bar represents 10% of patients who receive Active Surveillance

A doctor’s perspective “We desperately need the ability to predict which patient has a localized cancer that is going to metastasize and cause suffering and death, and which patient has a cancer that is destined to stay in the patient's prostate for the remainder of his life.”  -Otis W. Brawley, MD Chief Medical Officer American Cancer Society Reference Graff St. Overdiagnosis Since Introduction of Prostate Cancer Screening. JNCI J Natl Cancer Inst (2009) 101 (19): 1293.

Understanding your treatment options IMMEDIATE TREATMENT ACTIVE SURVEILLANCE* OR Potential Benefits Men may be cured if: Tumor has not spread All cancer is removed Radiation kills all the cancer Potential Risks Urinary incontinence Erectile dysfunction 30-40% chance of recurrence Use of a catheter for 1-2 weeks Bowel control issues or rectal bleeding (for radiation) Potential Benefits Maintains window of cure Allows men with low-risk cancer to: Closely monitor their cancer Live out their entire lives without surgery or radiation Avoid the side effects associated with surgery and radiation Potential Risks Slight risk that cancer may grow and spread With a schedule of close monitoring it should be caught before it spreads SURGERY Reference: Patient Education Brochure RADIATION *Includes biopsy; DRE (Digital Rectal Exam), PSA (Prostate-Specific Antigen) testing, and MRI (Magnetic Resonance Imaging)

What is Active Surveillance? A program of closely monitoring and following your prostate cancer avoiding surgery or radiation. Periodic examinations may include*: PSA Testing Digital Rectal Exam (DRE) Surveillance Biopsy Magnetic Resonance Imaging(MRI) If any changes are detected your doctor may recommend additional treatment Reference: Patient Education Brochure * Timing and frequency of these examinations will be specified for you by your doctor

Who is eligible for Active Surveillance? Up to HALF of men with low risk cancer could be candidates for Active Surveillance Reference: Klotz L1. Emberton M. Management of low risk prostate cancer: active surveillance and focal therapy. Curr Opin Urol. 2014 May;24(3):270-9. Your doctor will assess your clinical risk (an estimation of your cancer's aggressiveness) to confidently recommend Active Surveillance

10+ years of genomic experience is a leading provider of genomic cancer diagnostic tests: Available TODAY The Oncotype DX Test - 10 Years and Beyond https://www.youtube.com/watch?v=rWb2ruML848   Over the past decade, Genomic Health has redefined personalized medicine through the innovation of Oncotype DX, making genomics an indispensable part of breast, colon and prostate cancer diagnosis and treatment. In its next decade, Genomic Health aims to lead the transformation of cancer into a manageable disease with the goal of reducing the high toll of cancer on both the individual and society. In this way, Genomic Health will continue to shape a world in which genomic information is truly life, changing. 2004 2010 2013

Principles of genomics Genomics examines groups of genes and their relationships in order to identify their combined influence on your cancer’s behavior* Oncotype DX® assay evaluates genes for: Cell division Cell organization Cell aggressiveness Reference: Prostate Sales Aid *At time of diagnosis

The Oncotype DX® test provides personalized information Predicts the UNIQUE BIOLOGY of your tumor based on biopsy tissue Examines the expression of a panel of GENES associated with prostate cancer pathology and progression, a science known as “genomics” Reference: Patient Education Brochure Provides a more specific and PRECISE risk assessment than clinical risk alone

Quick facts about Oncotype DX® Prostate Cancer Assay GPS Who is the test for? What is the Genomic Prostate Score (GPS)? What is Favorable Pathology? Reference: Patient Education Brochure Patients with very low to low-intermediate risk disease Your Oncotype DX® results are reported as a GPS, that when combined with other clinical factors, can further clarify your risk Confirmation that the tumor is low risk and fully confined to the prostate

Oncotype DX® along your prostate cancer journey SCREENING PSA DRE DIAGNOSIS Biopsy Gleason Stage TREATMENT DECISION Active Surveillance OR Immediate Treatment Reference: Patient Education Brochure It is a genomic test that gives you and your doctor confidence to choose the best management plan for your cancer

GPS helps provide a precise risk assessment VERY LOW INTERMEDIATE LOW Reference: Patient Education Brochure Likelihood of favorable pathology 100 More favorable Less favorable

Know your score. Know your risk. The LOWER YOUR GPS, the more favorable your tumor biology, and the more likely you can safely consider Active Surveillance The HIGHER YOUR GPS, the less favorable your tumor biology, and the more likely that you should consider Immediate Treatment Reference: Patient Education Brochure

A patient’s perspective Choose with confidence “I was determined to educate myself about all of my options, and thanks to Oncotype DX®, I confidently chose Active Surveillance based on my GPS result.” -Dan W. Oncotype DX® Prostate Cancer Patient Ambassador Your Prostate, Your Decision: A Patient's Perspective https://www.youtube.com/watch?v=iWJYeysRAQ8 A prostate cancer patient shares his story to help raise awareness that men need to gather all the facts before choosing surgery after a prostate cancer diagnosis.
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Financial assistance is available The Genomic Access Program (GAP) takes every possible step to ensure that testing is: Affordable Available Accessible If your potential out-of-pocket costs exceed $100, GAP will contact you by phone to help you understand these costs You are eligible regardless of your insurance status Genomic Health contracts directly with most insurers or third-party payers to secure the best coverage possible GAP contacts your insurance company to determine whether you are covered for the Oncotype DX® test You can prequalify for patient assistance on the spot simply by providing some basic financial information Genomic Access Program (GAP) Video: https://www.youtube.com/watch?v=N3z2OqBs_pg&feature=youtu.be Genomic Health CEO Kim Popovits and thought leading physicians talk about the Oncotype DX Prostate Cancer Assay and the Genomic Access Program (GAP), which assists prostate cancer patients with the insurance reimbursement process. Reference: Patient Education Brochure GAP Brochure

A patient’s perspective Choose with confidence “Gain as much information as possible to make the best decision for yourself.” -Dan W. Oncotype DX® Prostate Cancer Patient Ambassador ”

Your Prostate Your Decision www.YourProstateYourDecision.com Your Prostate Your Decision is a national campaign to educate patients and their loved ones that every man is different and every cancer is unique, and a genomic test can clarify the aggressiveness of one’s disease prior to invasive treatment. In partnership with three prominent national patient advocacy organizations (Men’s Health Network, PHEN, ZERO) and Joe Torre, four-time world champion baseball Hall-of-Famer and prostate cancer survivor, we are launching Your Prostate Your Decision campaign to educate patients and their loved ones that every man is different and every cancer is unique, and a genomic test can clarify the aggressiveness of one’s disease prior to invasive treatment.   This is a broad, multi-media patient education effort to provide tools to help patients have discussions with their health care team. The public service announcement featuring Joe Torre that begins to air/appear across the country this week, urges patients to discuss genomic testing with their physicians. The campaign’s website, www.YourProstateYourDecision.com, provides tools they need to have a more productive discussion with their doctor. This first-of-its-kind national effort aims to address concerning results of a large national survey conducted with support from MHN, PHEN and ZERO, that found low general awareness about prostate cancer aggressiveness and treatment options, underscoring the need for better understanding of active surveillance as a treatment plan. To view the website or watch the video with Joe Toree on YouTube, go to: http://www.YourProstateYourDecision.com http://youtu.be/OFwxS60sehQ Joe Torre, Prostate Cancer Survivor, 4-time World Champion and Baseball Hall-of-Famer Watch a public service announcement Featuring baseball Hall-of-Famer & prostate cancer survivor Joe Torre

Resources for your prostate cancer journey Reference: Online Resource Guide

1 2 3 4 Next steps LEARN MORE CONSIDER YOUR OPTIONS ASK YOUR DOCTOR about your prostate cancer CONSIDER YOUR OPTIONS you have time to choose with confidence ASK YOUR DOCTOR about the Oncotype DX® Prostate Cancer Assay CALL +1-855-6PROSTATE 2 3 4

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