Genomic Classifier Tests Play Heterogeneous Role in Prostate Cancer Risk Classification
TUESDAY, Jan. 21, 2025 -- For patients with localized prostate cancer (PCa), tissue-based genomic classifiers (GCs) do not consistently influence risk classification or treatment decisions, according to a review published online Jan. 21 in the Annals of Internal Medicine.
Amir Alishahi Tabriz, M.D., Ph.D., M.P.H., from the Moffitt Cancer Center in Tampa, Florida, and colleagues conducted a systematic review to summarize the impact of the Decipher, Oncotype DX Genomic Prostate Score (GPS), and Prolaris GCs on risk stratification and patient-clinician decisions regarding treatment choice among patients with localized PCa considering first-line treatment. Studies on risk classification and treatment choice after GC testing were independently identified by two investigators.
The researchers identified 10 studies that reported on risk reclassification after GC testing. Very low-risk or low-risk patients with PCa were more likely to have their risk levels classified as the same or lower in observational studies with a low risk for bias (GPS: 100 to 88.1 percent; Decipher: 87.2 to 82.9 percent; Prolaris: 76.9 percent). GC testing with GPS reclassified 34.5 and 29.4 percent of very low-risk and low-risk patients, respectively, to a higher risk category in one randomized study. Treatment decisions after GC testing either remained unchanged or slightly favored active surveillance based on 12 observational studies; however, in analyses from a single randomized trial, fewer choices for active surveillance after GPS testing were seen.
"Although GC tests do not consistently influence risk classification or treatment decisions, the differences observed between observational and randomized studies highlight a need for well-designed trials to explore the role of GC tests in patients with newly diagnosed PCa considering first-line treatment," the authors write.
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