Patients classified as high-risk by the genomic classifier who underwent radical prostatectomy had a 3-fold higher risk of harboring adverse pathology at the time of surgery compared with those with low-risk.
Real-world data obtained from a population-based registry demonstrated the utility of the Decipher 22-gene genomic classifier in guiding treatment decisions for patients with prostate cancer.1,2
The findings were recently published in JNCI Cancer Spectrum.
"Validation from multiple randomized trials has consistently demonstrated the prognostic performance of the Decipher 22-gene expression test. This study builds upon this with real-world data of how the test is being used in a population sample and demonstrates how we are moving toward the goal of personalized therapy. Patients with a low Decipher score, indicating a better prognosis, can be guided towards treatment de-escalation, and those with higher Decipher scores, indicating a worse prognosis, can be guided towards appropriate treatment,” said Daniel E. Spratt, MD, in a news release on the findings.2 Spratt is the chair of radiation oncology at University Hospitals Seidman Cancer Center and a professor at Case Western Reserve University School of Medicine in Cleveland, Ohio.
For the study, prostate cancer case data were obtained from the Surveillance, Epidemiology, and End Results program registries and were linked to Decipher testing records. In total, 572,545 patients were identified for analysis, of which 8927 patients underwent testing with the genomic classifier. The investigators assessed the association between Decipher results and the use of active surveillance and watchful waiting (AS/WW) and adverse pathology at the time of radical prostatectomy.
Data showed that patients who underwent testing with the genomic classifier were more likely to be placed on AS/WW compared with patients who were not biopsied with the test (OR [95% CI] 2.21 [2.04-2.38]; P < .001). In total, 41% of patients classified as low-risk by the genomic classifier were placed on AS/WW, compared with 27% with intermediate-risk disease and 11% with high-risk disease (P < .001).
Among patients classified as higher-risk by the genomic classifier who underwent subsequent radical prostatectomy, there was a 3-fold higher risk of harboring adverse pathology at the time of surgery compared with those classified as low-risk (OR 2.94 [1.38-6.27]; P = .005).
Further, higher Decipher risk score was associated with greater use of local therapy among patients classified as NCCN low- or favorable intermediate-risk (OR 4.79 [3.51-6.55]; P < .001). The investigators also observed that the use of post-operative radiotherapy increased with Decipher risk group, with 16% of low-risk patients undergoing radiotherapy, compared with 24% of intermediate-risk patients and 35% of high-risk patients.
A similar trend was observed with the use of radical prostatectomy, with 22% of low-risk patients, 30% of intermediate-risk patients, and 39% of high-risk patients undergoing surgery (OR 2.69 [1.89-3.84]).
“This study is further evidence that the Decipher Prostate test provides valuable clinical information to physicians and their patients with prostate cancer,” concluded Veracyte’s urology medical director, Elai Davicioni, PhD, in the news release.2
1. Zaorsky NG, Proudfoot JA, Jia AY, et al. Use of the Decipher genomic classifier among men with prostate cancer in the United States. JNCI Cancer Spectr. Published online August 1, 2023. Accessed August 7, 2023. doi:10.1093/jncics/pkad052
2. Study published in JNCI Cancer Spectrum demonstrated real-world utility of Veracyte’s Decipher Prostate Genomic Classifier in prostate cancer treatment. News release. Veracyte Inc. August 1, 2023. Accessed August 7, 2023. https://www.businesswire.com/news/home/20230801227697/en