ASCO GU 2023: The Impact of Genomic Biomarkers on a Validated Clinical Risk Prediction Model for Upgrading/upstaging Among Men with Low-Risk Prostate Cancer

( Braun et al. (UCSF) evaluated the impact of genomic biomarkers on a validated Clinical Risk Prediction Model (CapSURE) for Upgrading/Upstaging among men with Low-risk prostate cancer (LR PC).

In this manuscript, the authors aimed to assess the impact of adding various genomic classifiers (GCs) to an established clinical prediction model to better guide treatment decision management of men with LR PC. The hope is that GC may help better risk stratify patients with LR PC put on active surveillance (AS) and help distinguish men with aggressive disease that warrants intervention.

To that effect, they used multivariate logistic regression and receiver operating characteristic (ROC) curves to develop a prediction model for upgrading and upstaging (UG/US) in men with low-risk, low-volume intermediate-risk PCa who were potential candidates for AS. The model was developed among 864 men (UCSF) and validated in an independent cohort of 2,267 men (CapSURE database) with similar risk profiles. They included men low risk low volume PC (cT1-2, PSA <= 15) and GG1 or low volume GG2 (<33% cores).

After computing areas under the ROC curve (AUC) from these probabilities, they tested the model’s predictive ability with the addition of a series of GCs (OncoType Dx Genomic Prostate Score, Decipher score, and selected Decipher GRID scores) using the logistic model constructed for the development cohort to estimate the predicted probability of UG/US.

The main results are presented below:


The prediction model had 5 variables associated with UG/US – PSA, secondary Gleason score, % positive cores, prostate volume, and age. Average AUC was 0.70.

Of the various GCs, Genomic Prostate Score (GPS) was the only one independently associated with risk of UG/US when added to the model. The average AUC was 0.72, not much higher than the model alone.

Based on this, they appropriately conclude that the addition of GCs to a validated rich model incorporating detailed clinical variables, when applied to favorable-risk PCa patients, did not substantially improve prediction of UG/US. Their findings suggest that widespread use of biomarkers to guide management or the intensity of follow up may not be supported in men with low-risk, low-volume disease pursuing AS.

Presented by: Avery Braun, DO, Einstein Medical Center, Philadelphia, PA

Written by: Thenappan (Thenu) Chandrasekar, MD – Urologic Oncologist, Associate Professor of Urology, University of California, Davis @tchandra_uromd on Twitter during the 2023 Genitourinary (GU) American Society of Clinical Oncology (ASCO) Annual Meeting, San Francisco, Thurs, Feb 16 – Sat, Feb 18, 2023.