EAU 2017: Decipher test impacts decision-making among patients considering adjuvant and salvage treatment following radical prostatectomy: Interim results from the multicenter prospective PRO-IMPACT study

London, England (UroToday.com) There is significant uncertainty on the appropriate timing for adjuvant or salvage radiation therapy (ART, SRT) after radical prostatectomy (RP). The Decipher test (GenomeDx Biosciences Inc., San Diego) measures the expression levels of 22 RNA biomarkers involved in multiple biological pathways across the genome that are associated with aggressive prostate cancer. Using the expression of these biomarkers, the test calculates the probability of clinical metastasis within 5 years of RP. This study prospectively evaluated the impact of the Decipher test on physicians’ decision to administer ART and SRT in these patients.

In total, 265 patients were enrolled (150 patients for ART and 115 for SRT). Participating physicians’ submitted a management recommendation prior and post administration of the Decipher test. In addition, patients completed validated surveys on prostate cancer-specific quality of life, cancer related anxiety and decision quality.

Before administration of the Decipher test, observation was recommended for 89% of ART considered patients and 58% of SRT considered patients. However, after the administration of the Decipher test, 18% (95% CI 12-25%) of treatment recommendations changed in the ART arm (including 31% of high-risk Decipher patients), and 32% (95% CI 24-42%) of management recommendations changed in the SRT arm (including 56% of high-risk Decipher patients). Decisional Conflict Scale (DCS) scores decreased (indicating higher decision quality) after receiving Decipher test results. For ART the median DCS pre-Decipher was 25 [IQR 8-44] and median DCS post-Decipher was 19 [IQR 2-30], p<0.001. For SRT the median pre-Decipher was 27 [IQR 16-41] and median post-Decipher was 23 [IQR 4-30], p<0.001.

Prostate cancer-specific anxiety changed following exposure to Decipher test results. Fear of prostate cancer recurrence in the ART arm (p=0.02) and prostate cancer-specific anxiety in the SRT arm (p=0.05) decreased significantly among Decipher low-risk patients. Decipher results were associated with the decision to pursue ART (OR 1.48; 95% CI 1.19-1.85) and SRT (OR 1.41; 95% CI 1.09-1.81) in multivariable logistic regression analysis.

In conclusion, Decipher test results were associated with better treatment decision-making and improved decision quality among men with prostate cancer after RP considered for either ART or SRT.

Speaker(s): Gore J., Du Plessis M., Santiago-Jimenez M., Yousefi K., Thompson D., Karsh L., Lane B., Franks M., Chen D., Bandyk M., Bianco Jr. F.1 Brown G., Clark W., Kibel A., Kim H.14, Lowrance W., Manoharan M., Maroni P., Perrapato S., Sieber P., Trabulsi E., Waterhouse R., Davicioni E., Lotan Y., Lin DW.

at the #EAU17 - March 24-28, 2017- London, England
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