Association Between a 22-feature Genomic Classifier and Biopsy Gleason Upgrade During Active Surveillance for Prostate Cancer.

Although the Decipher genomic classifier has been validated as a prognostic tool for several prostate cancer endpoints, little is known about its role in assessing the risk of biopsy reclassification for patients on active surveillance, a key event that often triggers treatment.

To evaluate the association between Decipher genomic classifier scores and biopsy Gleason upgrading among patients on active surveillance.

This was a retrospective cohort study among patients with low- and favorable intermediate-risk prostate cancer on active surveillance who underwent biopsy-based Decipher testing as part of their clinical care.

We evaluated the association between the Decipher score and any increase in biopsy Gleason grade group (GG) using univariable and multivariable logistic regression. We compared the area under the receiver operating characteristic curve (AUC) for models comprising baseline clinical variables with or without the Decipher score.

We identified 133 patients for inclusion with a median age of 67.7 yr and median prostate-specific of 5.6 ng/ml. At enrollment, 75.9% had GG1 and 24.1% had GG2 disease. Forty-three patients experienced biopsy upgrading. On multivariable logistic regression, the Decipher score was significantly associated with biopsy upgrading (odds ratio 1.37 per 0.10 unit increase, 95% confidence interval [CI] 1.05-1.79; p = 0.02). The Decipher score was associated with upgrading among patients with biopsy GG 1 disease, but not GG2 disease. The discriminative ability of a clinical model (AUC 0.63, 95% CI 0.51-0.74) was improved by integration of the Decipher score (AUC 0.69, 95% CI 0.58-0.80).

The Decipher genomic classifier score was associated with short-term biopsy Gleason upgrading among patients on active surveillance.

The results from this study indicate that among patients with prostate cancer undergoing active surveillance, those with higher Decipher scores were more likely to have higher-grade disease found over time. These findings indicate that the Decipher test might be useful for guiding the intensity of monitoring during active surveillance, such as more frequent biopsy for patients with higher scores.

European urology open science. 2022 Feb 11*** epublish ***

Benjamin H Press, Tashzna Jones, Olamide Olawoyin, Soum D Lokeshwar, Syed N Rahman, Ghazal Khajir, Daniel W Lin, Matthew R Cooperberg, Stacy Loeb, Burcu F Darst, Yingye Zheng, Ronald C Chen, John S Witte, Tyler M Seibert, William J Catalona, Michael S Leapman, Preston C Sprenkle

Department of Urology, Yale School of Medicine, New Haven, CT, USA., Department of Urology, University of Washington, Seattle, WA, USA., Department of Urology, University of California-San Francisco, San Francisco, CA, USA., Departments of Urology and Population Health, New York University Langone Health and Manhattan Veterans Affairs Medical Center, New York, NY, USA., University of Southern California Center for Genetic Epidemiology, Keck School of Medicine, Los Angeles, CA, USA., Fred Hutchinson Cancer Research Center, Cancer Prevention Program, Public Health Sciences, Seattle, WA, USA., Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA., Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA., Department of Radiation Medicine and Applied Sciences, University of California-San Diego, La Jolla, CA, USA., Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

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