Validation of a genomic classifier for predicting post-prostatectomy recurrence in a community-based healthcare setting.

To determine the value of Decipher, a genomic classifier, to predict prostate cancer outcomes among patients following prostatectomy in a community health care setting.

We examined the experience of 224 men treated with radical prostatectomy (RP), 1997-2009, at Kaiser Permanente Northwest, a large prepaid health plan in Portland, Oregon.

Study subjects had aggressive prostate cancer with at least one of the following criteria: pre-operative prostate specific antigen (PSA) ≥ 20 ng/ml, Pathologic Gleason score ≥ 8, stage pT3, or positive surgical margins at prostatectomy. The primary endpoint was clinical recurrence or metastasis after surgery evaluated using a time-dependent c-index. Secondary endpoints were biochemical recurrence and salvage treatment failure. We compared the performance of Decipher alone to the widely used Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score and assessed the independent contributions of Decipher, CAPRA-S and their combination for the prediction of recurrence and treatment failure.

Of the 224 patients, 12 experienced clinical recurrence, 68 had biochemical recurrence and 34 failed salvage treatment. At 10 years after prostatectomy, the recurrence rate was 2. 6% among patients with low Decipher scores but 13. 6% among those with high Decipher scores (p=0. 02). When the CAPRA-S and Decipher scores were considered together, the discrimination accuracy of the ROC curve was increased by 0. 11 over the CAPRA-S score alone (combined c-index = 0. 84 at 10 years post-RP) for clinical recurrence.

Decipher improves our ability to predict clinical recurrence in prostate cancer and adds precision to conventional pathological prognostic measures.

The Journal of urology. 2015 Nov 25 [Epub ahead of print]

Andrew G Glass, Michael C Leo, Zaid Haddad, Kasra Yousefi, Marguerite du Plessis, Chuhe Chen, Voleak Choeurng, Firas Abdollah, Bruce Robbins, Seong Ra, Kathryn E Richert-Boe, Christine Buerki, Kathy Pearson, Elai Davicioni, Sheila Weinmann

Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.  Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA. , GenomeDx Biosciences, Vancouver, BC, Canada. , GenomeDx Biosciences, Vancouver, BC, Canada. , GenomeDx Biosciences, Vancouver, BC, Canada. , Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA. , GenomeDx Biosciences, Vancouver, BC, Canada. , Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA. , San Diego Pathologists Medical Group, San Diego, CA, USA. , San Diego Pathologists Medical Group, San Diego, CA, USA. , Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA. , GenomeDx Biosciences, Vancouver, BC, Canada. , Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA. , GenomeDx Biosciences, Vancouver, BC, Canada. , Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.

PubMed