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A High-Risk Decipher Biopsy Score is Associated with Conversion from Active Surveillance to Treatment and Treatment Failure in Localized Prostate Cancer - Beyond the Abstract

Genomic classifiers are used for prognostication and risk stratification in prostate cancer. Despite the emerging data, a commonly cited limitation is the retrospective datasets used for analysis. While there has been a litany of data using retrospective datasets to extrapolate the value of commercially available platforms in the pretreatment setting, the evaluation of these assays using prospectively collected data is still needed.


Leveraging the prospectively collected statewide Michigan Urological Surgery Improvement Collaborative (MUSIC), a compilation of community and academic urology practices within Michigan, the real-world utility of the Decipher Biopsy test was assessed in 855 patients who underwent clinical Decipher Biopsy testing from 2015-2019. In the 31% of men who underwent active surveillance based on their diagnostic biopsy results, a high-risk Decipher biopsy score was independently associated with a shorter time to treatment (HR 2.51, 95% CI 1.52-4.13, p<0.001). A high-risk Decipher biopsy score was also associated with a shorter time to biochemical failure or receipt of salvage therapy (HR 2.98, 95% CI 1.22-7.29, p=0.01) following primary definitive treatment.1 These findings represent the first prospective study of clinical Decipher Biopsy testing utility.

Given the continued emergence of data regarding the utility of genomic classifiers, the need for prospective trials evaluating the benefit of these tests remains. The ongoing Genomics in Michigan to Adjust Outcomes in Prostate Cancer (G-MAJOR, NCT04396808) trial will provide assess the impact of Decipher, Prolaris, and Oncotype Dx in newly diagnosed patients through a 900 patient randomized controlled trial. 

Written by: Udit Singhal, MD1,2 Randy A. Vince Jr., MD, MS 1,2

  1. Department of Urology, University of Michigan, Ann Arbor, Michigan
  2. University of Michigan Rogel Cancer Center, Ann Arbor, Michigan

References:

  1. Vince, R.A., Jiang, R., Qi, J. et al. Impact of Decipher Biopsy testing on clinical outcomes in localized prostate cancer in a prospective statewide collaborative. Prostate Cancer Prostatic Dis (2021). https://doi.org/10.1038/s41391-021-00428-y

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