(UroToday.com) The 2026 GU ASCO annual meeting featured a prostate cancer session and a presentation by Dr. Michael Leapman discussing the association between genomic classifier scores and initial management of localized prostate cancer in a population-based cohort in the United States.
Tissue-based gene expression assays provide prognostic information in prostate cancer, but their independent clinical value, particularly in guiding the use of initial treatment versus active surveillance, remains uncertain. As such, Dr. Leapman and colleagues evaluated the association between results of a 22-gene genomic classifier and initial management in a novel, population-based sample linking genomic and clinical data.
This study leveraged the SEER – Decipher linked database, which integrates incident prostate cancer diagnoses during 2010-2018 with Decipher Prostate genomic classifier test orders and results. Patients included in this analysis had low-risk or favorable intermediate-risk prostate cancer, underwent biopsy-based genomic classifier testing, and had complete demographic and clinical data (PSA, Gleason grade group, stage, NCCN risk category). The first-course management was classified as immediate therapy (surgical or radiation) versus active surveillance. Genomic classifier scores were categorized based on commonly used thresholds: low (<0.45), intermediate (0.45–0.60), or high (>0.60). The investigators used multivariable logistic regression to assess the association between the receipt of active surveillance versus immediate treatment and genomic classifier scores, adjusting for demographic, clinical, and pathological covariates, with stratification by clinical risk group (low- or intermediate-risk).
Among 2,547 men with low- or favorable intermediate-risk prostate cancer, 744 (72.2%) with low-risk disease and 404 (26.6%) with intermediate-risk disease were managed initially with active surveillance. In those with low NCCN risk disease, the proportion managed with initial active surveillance was higher in those with low genomic classifier scores (419/527 [79.5%]), compared to 218/304 (71.7%) with intermediate genomic classifier scores and 107/199 (53.8%) with high genomic classifier scores (p < 0.001).
Similarly, among those with intermediate-risk disease, active surveillance was more common in those with low genomic classifier scores (239/562 [42.5%]) compared to 103/425 (24.2%) with intermediate genomic classifier scores and 62/530 (11.7%) with high genomic classifier scores (p < 0.001). In the low-risk group, higher genomic classifier scores were independently associated with lower odds of active surveillance versus treatment (compared to low genomic classifier, intermediate genomic classifier: OR 0.69, 95% CI 0.49–0.97, p = 0.033; high genomic classifier: OR 0.29, 95% CI 0.20–0.43, p < 0.001). In the intermediate-risk group, the associations were of greater magnitude (intermediate genomic classifier: OR 0.42, 95% CI 0.31–0.57, p < 0.001; high genomic classifier: OR 0.19, 95% CI 0.14–0.27, p < 0.001).
Dr. Leapman concluded his presentation discussing the association between genomic classifier scores and initial management of localized prostate cancer in a population-based cohort in the United States by noting that higher genomic classifier scores were independently associated with lower odds of active surveillance among men with low- or intermediate-risk prostate cancer in the United States
Presented by: Michael S. Leapman, MD, MHS, Urologist, Yale Cancer Center, New Haven, Connecticut
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