San Antonio, Texas USA (UroToday.com) Salvage treatment for patients after radical prostatectomy (RP) with biochemical recurrence (BCR) is controversial. The genomic classifier, “Decipher”, was developed in order to better risk stratify patients after RP and assist in the decision to proceed with adjuvant therapy and was tested in 359 patients. However, the clinical utility of the “Decipher “classifier was not prospectively evaluated in patients after RP that developed BCR. The aim of the authors in this study was to assess the influence of the “Decipher” test on urologist’s decision on salvage treatment in patients with BCR.
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Treatment recommendations were given by the treating urologist separately before and after the “Decipher” test results were reviewed. The level of confidence of the physician and patient in the given recommendations before and after reviewing the “Decipher” test results was measured by validated questionnaires. Patients were seen at 6 and 18 months after salvage treatment.
125 patients were enrolled in the study, out of which 114 completed the mentioned follow-up period. In 32% (95%CI 24%-42%) of the patients, treatment recommendation changed after the “Decipher” test results were reviewed. In 27% (95% CI 17-39%) of the patients an initial observation recommendation was changed to active treatment. In the Decipher low risk group the proportion of patients assigned to observation increased after test results were reviewed while the proportion of patients assigned to active treatment decreased. On the other hand in the high risk group, an exact opposite trend was observed. Lastly the decision confidence of both patients and physicians, measured by the decision conflict scale, improved after reviewing the tests results (33 vs 25 and 33 vs 29 for patients and physicians respectively)
In conclusion, the knowledge of the “Decipher” classifier impacted the decision on salvage treatment in patients with BCR after RP. Low risk patients recommendations tended to shift towards observation while high risk patients recommendations shifted towards active treatment. Furthermore, both patients and physicians confidence in the recommendation increased with the “Decipher” test. This study highlights the role the “Decipher” test has in patient with BCR
Authors: John L. Gore, Marguerite du Plessis, Maria Santiago-Jimenez, Kasra Yousefi, Darby Thompson, Mark Bandyk, Fernando Bianco, Gordon Brown, David Chen, William Clark, Michael Franks, Lawrence Karsh, Adam Kibel, Hyung Kim, Brian Lane, Yair Lotan, William Lawrence, Murugesan Manoharan, Paul Maroni, Scott Perrapato, Paul Sieber, Eduard Trasbulsi, Robert Waterhouse, Elia Davicioni, Daniel Lin
Written By: Miki Haifler, MD, SUO Fellow, Fox Chase Cancer Center
17th Annual Meeting of the Society of Urologic Oncology - November 30 -December 2, 2016 – San Antonio, Texas USA