Decipher identifies men with otherwise clinically favorable-intermediate risk disease who may not be good candidates for active surveillance

Abstract

Background We aimed to validate Decipher to predict adverse pathology (AP) at radical prostatectomy (RP) in men with National Comprehensive Cancer Network (NCCN) favorable-intermediate risk (F-IR) prostate cancer (PCa), and to better select FIR candidates for active surveillance (AS). Methods In all, 647 patients diagnosed with NCCN very low/low risk (VL/LR) or FIR prostate cancer were identified from a multi-institutional PCa biopsy database; all underwent RP with complete postoperative clinicopathological information and Decipher genomic risk scores. The performance of all risk assessment tools was evaluated using logistic regression model for the endpoint of AP, defined as grade group 3−5, pT3b or higher, or lymph node invasion. Results The median age was 61 years (interquartile range 56-66) for 220 patients with NCCN FIR disease, 53% classified as low-risk by Cancer of the Prostate Risk Assessment (CAPRA 0−2) and 47% as intermediate-risk (CAPRA 3−5). Decipher classified 79%, 13% and 8% of men as low-, intermediate-and high-risk with 13%, 10%, and 41% rate of AP, respectively. Decipher was an independent predictor of AP with an odds ratio of 1.34 per 0.1 unit increased (p value = 0.002) and remained significant when adjusting by CAPRA. Notably, FIR with Decipher low or intermediate score did not associate with significantly higher odds of AP compared to VL/LR. Conclusions NCCN risk groups, including FIR , are highly heterogeneous and should be replaced with multivariable riskstratification. In particular, incorporating Decipher may be useful for safely expanding the use of AS in this patient population.

Association Between a 22-feature Genomic Classifier and Biopsy Gleason Upgrade During Active Surveillance for Prostate Cancer

“…In this cohort, the Decipher score was an independent predictor of adverse pathology, i.e., high-grade and/or high-stage at prostatectomy, (OR 1.34 per 0.1 unit increase, 95% CI 1.11-1.63). 13 Similarly, Kim and colleagues analyzed Decipher scores from the biopsies of 266 patients with NCCN very-low, low-, and favorable-intermediate-risk prostate cancer and also reported that the Decipher score was an independent predictor of adverse pathology on prostatectomy (odds ratio 1.29 per 10% increase, 95% CI 1.03-1.61 per 0.1 unit increase). 25 However, by directly evaluating outcomes of patients actually on active surveillance, we identified a significant association of Decipher test results and tumor upgrading.…”

Biomarker in Active Surveillance for Prostate Cancer: A Systematic Review

“…Kim et al [ 83 ] and Herleman et al [ 84 ] evaluated the ability of Decipher© to predict adverse pathology in patients with NCCN favourable-intermediate risk PCa who undergone a RP at first treatment. Decipher was an independent predictor of adverse pathology and adding Decipher improved the CAPRA score.…”

Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice

“…This test incorporates 22 coding and non-coding genes that cover seven cancer pathways, including angiogenesis, invasion and metastasis, or growth and differentiation [50]. It generates a score ranging from 0 to 1, with higher values indicating an increased probability for both AP and poorer oncologic outcomes [52].…”