Decipher is a validated genomic classifier developed to determine the biological potential for metastasis after radical prostatectomy (RP).
To evaluate the ability of biopsy Decipher to predict metastasis and Prostate cancer-specific mortality (PCSM) in primarily intermediate- to high-risk patients treated with RP or radiation therapy (RT).
Two hundred and thirty-five patients treated with either RP (n=105) or RT±androgen deprivation therapy (n=130) with available genomic expression profiles generated from diagnostic biopsy specimens from seven tertiary referral centers. The highest-grade core was sampled and Decipher was calculated based on a locked random forest model.
Metastasis and PCSM were the primary and secondary outcomes of the study, respectively. Cox analysis and c-index were used to evaluate the performance of Decipher.
With a median follow-up of 6 yr among censored patients, 34 patients developed metastases and 11 died of prostate cancer. On multivariable analysis, biopsy Decipher remained a significant predictor of metastasis (hazard ratio: 1.37 per 10% increase in score, 95% confidence interval [CI]: 1.06-1.78, p=0.018) after adjusting for clinical variables. For predicting metastasis 5-yr post-biopsy, Cancer of the Prostate Risk Assessment score had a c-index of 0.60 (95% CI: 0.50-0.69), while Cancer of the Prostate Risk Assessment plus biopsy Decipher had a c-index of 0.71 (95% CI: 0.60-0.82). National Comprehensive Cancer Network risk group had a c-index of 0.66 (95% CI: 0.53-0.77), while National Comprehensive Cancer Network plus biopsy Decipher had a c-index of 0.74 (95% CI: 0.66-0.82). Biopsy Decipher was a significant predictor of PCSM (hazard ratio: 1.57 per 10% increase in score, 95% CI: 1.03-2.48, p=0.037), with a 5-yr PCSM rate of 0%, 0%, and 9.4% for Decipher low, intermediate, and high, respectively.
Biopsy Decipher predicted metastasis and PCSM from diagnostic biopsy specimens of primarily intermediate- and high-risk men treated with first-line RT or RP.
Biopsy Decipher predicted metastasis and prostate cancer-specific mortality risk from diagnostic biopsy specimens.
European urology. 2017 May 19 [Epub]
Paul L Nguyen, Zaid Haddad, Ashley E Ross, Neil E Martin, Samineh Deheshi, Lucia L C Lam, Jijumon Chelliserry, Jeffrey J Tosoian, Tamara L Lotan, Daniel E Spratt, Radka S Stoyanova, Sanoj Punnen, Kaye Ong, Christine Buerki, Maria Aranes, Tyler Kolisnik, Jennifer Margrave, Kasra Yousefi, Voleak Choeurng, Elai Davicioni, Bruce J Trock, Christopher J Kane, Alan Pollack, John W Davis, Felix Y Feng, Eric A Klein
Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School, Boston, MA, USA. Electronic address: ., GenomeDx Biosciences Inc., Vancouver, BC, Canada., James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA., Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School, Boston, MA, USA., Department of Radiation Oncology, Michigan Center for Translational Pathology, Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA., Department of Radiation Oncology, Miller School of Medicine University of Miami, Miami, FL, USA., Department of Urology, University of California, San Diego, San Diego, CA, USA., Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA, USA., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.