Decipher correlation patterns post prostatectomy: initial experience from 2 342 prospective patients

Abstract

Background:Currently, there are multiple commercially available RNA-based biomarkers that are Medicare approved and suggested for use by the National Comprehensive Cancer Network guidelines. There is uncertainty as to which patients benefit from genomic testing and for whom these tests should be ordered. Here, we examined the correlation patterns of Decipher assay to understand the relationship between the Decipher and patient tumor characteristics.Methods:De-identified Decipher test results (including Decipher risk scores and clinicopathologic data) from 2 342 consecutive radical prostatectomy (RP) patients tested between January and September 2015 were analyzed. For clinical testing, tumor specimen from the highest Gleason grade was sampled using a 1.5 mm tissue punch. Decipher scores were calculated based on a previously locked model. Correlations between Decipher score and clinicopathologic variables were computed using Spearman's rank correlation. Mixed-effect linear models were used to study the association of practice type and Decipher score. The significance level was 0.05 for all tests.Results:Decipher score had a positive correlation with pathologic Gleason score (PGS; r=0.37, 95% confidence interval (CI) 0.34−0.41), pathologic T-stage (r=0.31, 95% CI 0.28−0.35), CAPRA-S (r=0.32, 95% CI 0.28−0.37) and patient age (r=0.09, 95% CI 0.05-0.13). Decipher reclassified 52%, 76% and 40% of patients in CAPRA-S low-, intermediate- and high-risk groups, respectively. We detected a 28% incidence of high-risk disease through the Decipher score in pT2 patients and 7% low risk in pT3b/pT4, PGS 8−10 patients. There was no significant difference in the Decipher score between patients from community centers and those from academic centers (P=0.82).Conclusions:Although Decipher correlated with baseline tumor characteristics for over 2 000 patients, there was significant reclassification of tumor aggressiveness as compared to clinical parameters alone. Utilization of the Decipher genomic classifier can have major implications in assessment of postoperative risk that may impact physician-patient decision making and ultimately patient management.

Transcriptome evaluation of the relation between body mass index and prostate cancer outcomes

“…This may have resulted in a patient selection bias for those who are fit for general anesthesia and do not have significant comorbidities that may be found in men with more severe degrees of obesity. Obesity has been associated with an increased incidence of positive surgical margins at prostatectomy . As such, patients with an extremely high BMI may not have been included in this patient cohort.…”

“…The Decipher score readout is a continuous score between 0 and 1, with higher scores indicating a greater risk of developing metastasis. Decipher scores were categorized into low‐risk (<0.45), intermediate‐risk (0.45‐0.60), and high‐risk groups (>0.60) with previously established and validated cut points …”

Prediction of biochemical recurrence in prostate cancer patients who underwent prostatectomy using routine clinical prostate multiparametric MRI and decipher genomic score

“…Gene expression profiling was performed using the Affymetrix microarray. Decipher score (continuous variable ranging from 0 to 1) was calculation based on a proprietary algorithm previously described . Decipher test reports, which stratify patients into three risk groups based on scores (0 to 0.44: low, 0.45 to 0.60: average and 0.61 to 1.0: high risk) were used as categorical variables.…”

Tissue-based biomarkers in prostate cancer

“…[37] A prospective analysis of 2,342 RP patients found positive correlation with the GC score and baseline tumor characteristics, but also found a substantial amount of risk reclassification with the aid of the Decipher™ assay. [38] Assuming all men with pT3 or positive margins received adjuvant RT, this study modeled that the use of the Decipher™ test would reduce usage by nearly 36% theoretically. While not as drastic of a reduction as seen in the aforementioned retrospectively created model,[36] this provides evidence from prospectively collected specimens.…”