Genomic testing linked to higher surveillance uptake
November 1, 2017
In men with clinically low-risk prostate cancer managed in community-based urology practices, utilization of active surveillance as initial management is higher among those who undergo genomic testing.
Boston-In men with clinically low-risk prostate cancer managed in community-based urology practices, utilization of active surveillance (AS) as initial management is higher among those who undergo genomic testing.
Persistence on AS is also greater in those having genomic testing, according to the results of an interim analysis in an observational cohort of men.
Investigators led by Gregg Eure, MD, examined the impact of a 17-gene assay (Oncotype DX) on the management of patients with clinically low-risk prostate cancer from 26 community-based urology practices that were using AS at the time. They presented their analysis at the AUA annual meeting in Boston and published the findings in Urology (2017; 107:67-75).
Based on an interim analysis of the first 297 participants, “We found that it’s very helpful in the low-grade, low-stage men who are considering AS to help the physician and the patient with a shared decision,” Dr. Eure told Urology Times.
The 17-gene assay is a validated, biopsy-based commercial gene expression assay that, when combined with clinical features, provides an individual estimate of disease aggressiveness at the time of prostate cancer diagnosis. From the assay, a Genomic Prostate Score (GPS) that predicts 10-year risk is derived.
The 26 community practices that contributed patients were all active users of AS. The investigators compared AS rates and persistence in the group of 297 that had GPS testing at these practices and a baseline group of 247 patients that did not receive GPS testing from the same practices.
“These were the same physicians and the same manner of diagnosis and counseling. The only variable that did change going forward was the addition of the GPS scores,” said Dr. Eure, chairman of research, Urology of Virginia, Virginia Beach. “Patients were told of their diagnosis, counseled, and given their GPS score, and follow-up visits were made within the next several weeks, followed by a decision made to pursue AS or not.”
One-year results were available in 258 of the 297 tested patients.
The utilization of AS in GPS-tested men increased, “and that result is durable out to 1 year. At 1 year, men who were tested with GPS were more likely to choose AS and stay on it than men who don’t have the benefit of the test,” Dr. Eure said.
The higher utilization and persistence on AS resulted in a 21% absolute increase (34% vs. 55%) and a 62% relative increase in the proportion of GPS-tested men on AS at 1 year post-diagnosis compared with baseline. The net increase of patients on AS at 1 year was observed across age groups and racial groups.
“We thought we were maxed out on our AS acceptance but using GPS improved that,” said Dr. Eure. “The individual risk refinement provided by genomic testing demonstrates the impact of the GPS in identifying appropriate patients and supporting more AS decisions in clinically low-risk prostate cancer.”
Dr. Eure is a consultant/adviser for Genomic Health, Inc. and has a financial or other relationship with several pharmaceutical companies. Several of his co-authors are employees of and have an investment interest with Genomic Health, and several co-authors have disclosures related to Genomic Health and/or pharmaceutical companies.