Tissue-based genomic classifiers (GCs) have been developed to improve prostate cancer (PCa) risk assessment and treatment recommendations.
To summarize the impact of the Decipher, Oncotype DX Genomic Prostate Score (GPS), and Prolaris GCs on risk stratification and patient-clinician decisions on treatment choice among patients with localized PCa considering first-line treatment.
MEDLINE, EMBASE, and Web of Science published from January 2010 to August 2024.
Two investigators independently identified studies on risk classification and treatment choice after GC testing for patients with localized PCa considering first-line treatment.
Relevant data extracted by 1 researcher and overread by a second. Risk of bias (ROB) was assessed in duplicate.
Ten studies reported risk reclassification after GC testing. In low ROB observational studies, very low- or low-risk patients with PCa were more likely to have their risk levels classified as the same or lower (GPS, 100% to 88.1%; Decipher, 87.2% to 82.9%; Prolaris, 76.9%). However, 1 randomized trial found that GC testing with GPS reclassified 34.5% of very low-risk and 29.4% of low-risk patients to a higher risk category. Twelve observational studies indicated that treatment decisions after GC testing either remained unchanged or slightly favored active surveillance. In contrast, analyses from a single randomized trial found fewer choices for active surveillance after GPS testing.
Heterogeneity in screening patterns, risk-determination cutoffs, pathology, and clinical practices. Studies on treatment choice were moderate to high ROB.
Although GC tests do not consistently influence risk classification or treatment decisions, the differences observed between observational and randomized studies highlight a need for well-designed trials to explore the role of GC tests in patients with newly diagnosed PCa considering first-line treatment.
U.S. Department of Veterans Affairs. (PROSPERO: CRD42022347950).
Annals of internal medicine. 2025 Jan 21 [Epub ahead of print]
Amir Alishahi Tabriz, Matthew J Boyer, Adelaide M Gordon, David J Carpenter, Jeffrey R Gingrich, Sudha R Raman, Deepika Sirohi, Alexis Rompre-Brodeur, Joseph Lunyera, Fahmin Basher, Rhonda L Bitting, Andrzej S Kosinski, Sarah Cantrell, Belinda Ear, Jennifer M Gierisch, Morgan Jacobs, Karen M Goldstein
Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida (A.A.T.)., Durham VA Health Care System, Durham; and Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina (M.J.B.)., Durham VA Health Care System, Durham, North Carolina (A.M.G., B.E., M.J.)., Department of Radiation Oncology, Wellstar Paulding Medical Center, Hiram, Georgia (D.J.C.)., Durham VA Health Care System, Durham; and Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina (J.R.G.)., Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina (S.R.R.)., Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah (D.S.)., Division of Urology, Department of Surgery, McGill University, Montreal, Canada (A.R.-B)., Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina (J.L.)., Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina (F.B.)., Durham VA Health Care System, Durham; and Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina (R.L.B.)., Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina (A.S.K.)., Duke University Medical Center Library and Archives, Duke University School of Medicine, Durham, North Carolina (S.C.)., Durham VA Health Care System, Durham; and Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham; and Department of Population Health, Duke University School of Medicine, Durham, North Carolina (J.M.G.)., Durham VA Health Care System, Durham; and Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina (K.M.G.).