Key Takeaways
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The Decipher Prostate genomic classifier — a genomic test performed on biopsy samples to gauge the expression of 22 genes involved in prostate cancer progression — was associated with Gleason upgrading among men on active surveillance for low- or favorable-intermediate-risk prostate cancer.
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Integration of the Decipher score improved the predictive power of baseline clinical features, although only modestly.
Why This Matters
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There is an unmet need to better identify patients with prostate cancer who will progress on active surveillance.
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Incorporating Decipher testing into standard clinical predictors might help guide decision-making surrounding active surveillance as well as the intensity of monitoring.
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Decipher has been validated as a predictor of PCa recurrence, metastasis, and mortality, but there has been little evidence until now for its value in active surveillance.
Study Design
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The study was a review of 133 men with prostate cancer under active surveillance. Decipher testing was performed on their baseline biopsy samples.
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The goal was to examine the association between the baseline Decipher score and Gleason upgrading on subsequent biopsies.
Key Results
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Forty-three patients (32%) had a biopsy upgrade.
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Decipher scores were significantly associated with biopsy upgrade (OR, 1.37 per 0.10 unit increase; P = .02).
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Decipher scores above a cutoff of 0.475 increased the odds of biopsy upgrade nearly fourfold (OR, 3.71; P = 0.01).
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Scores were associated with upgrade for Grade Group 1 disease (OR, 1.29 per 0.10 unit; P = .047) but not Grade Group 2 disease (P = .41).
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The discriminative ability of clinical predictors of progression increased with the integration of Decipher scores.
Limitations
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Patients at higher risk of progression may have been more likely to be tested.
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Sample size and follow-up were insufficient to assess long-term outcomes.
Disclosures
Funding source and investigator disclosures were not reported.
This is a summary of a preprint research report led by Benjamin Press of Yale University in New Haven, Conn., provided to you by Medscape. The study has not yet been peer-reviewed. The full text can be found at medrxiv.org.
M. Alexander Otto is a physician assistant with a master’s degree in medical science, and an award-winning medical journalist who has worked for several major news outlets before joining Medscape. He is an MIT Knight Science Journalism fellow. Email: [email protected]
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