(UroToday.com) The 2024 American Urological Association (AUA) Annual Meeting held in San Antonio, TX was host to a prostate cancer detection and screening moderated poster session. Dr. John Sheng presented the results of a study evaluating Decipher® score for prediction of clinically significant upgrading on final radical prostatectomy pathology.
The Decipher® genomic classifier is a 22-gene panel test that has been developed to predict the risk of metastasis prostate cancer patients. Current clinicopathologic variables (e.g., PSA, MRI) have limitations for the accurate risk stratification of patients in the pre-treatment setting. The objective of this study was to evaluate the association between pre-treatment Decipher® genomic classifier score mpMRI PI-RADS score on radical prostatectomy pathology.
This was a retrospective analysis of 760 patients from a single center who underwent Decipher® testing on prostate biopsy tissue between December 2016 and March 2023. Patient-level data for PSA, MRI PIRADS score, biopsy Grade Group, Decipher® score, and treatment modality were collected. Of these 760 patients, 142 underwent a radical prostatectomy. The primary outcome was Gleason Score upgrading from biopsy to radical prostatectomy. The associations between PSA, biopsy Grade Group, Decipher® score, and PI-RADS score and the primary study outcome of upgrading were assessed using multivariable ordinal logistic regression modeling.
The baseline patient characteristics are summarized below:
The final cohort included 104 patients who had an mpMRI, Grade Group 1-3 on biopsy, and Decipher® prior to prostatectomy. The investigators demonstrated that both Decipher® score (OR per 0.1 increase=1.27; p=0.043) and biopsy GG3 (OR versus GG1=8.2; p=0.003) were significantly associated with upgrading on radical prostatectomy, whereas there were no significant associations with PIRADS score (p=0.196) or PSA (p=0.217)
Dr. Sheng concluded that the Decipher® score and presence of GG3 disease on biopsy are significant predictors of upgrading on prostatectomy, while mpMRI (PIRADS) and PSA are not. Decipher® Genomics Resource for Intelligent Discovery (GRID) is a transcriptomic database which providers over 46,000 gene expressions. Future research could be directed at using Decipher® GRID to uncover gene expressions signatures that are correlated with clinically significant upgrading on radical prostatectomy pathology.
Presented by: John Sheng, MD, Society of Urologic Oncology (SUO) Fellow, Department of Urology, Washington University School of Medicine, St Louis, MI
Written by: Rashid Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2024 American Urological Association (AUA) Annual Meeting, San Antonio, TX, Fri, May 3 – Mon, May 6, 2024.