(UroToday.com) The 2023 SUO annual meeting included a session on prostate cancer, featuring a presentation by Dr. John Sheng discussing the influence of the Decipher genomic classifier on initial prostate biopsy Gleason Score upgrading on final radical prostatectomy pathology. Traditionally, PSA has been used to screen for prostate cancer. However, the utility of PSA has become controversial due to poor diagnostic accuracy. As such, other clinical tools such as prostate multiparametric MRI and genomic classifiers like Decipher genomic classifier are recommended to risk stratify newly diagnosed prostate cancer patients in the pre-treatment setting. While multiparametric MRI, and the Prostate Imaging-Reporting and Data System (PI-RADS), are considered predictive of prostatectomy pathology, Decipher genomic classifier has been shown to independently predict adverse pathology in patients with prostate cancer. The objective of this study presented at the SUO 2023 annual meeting was to examine the relationship between pre-treatment Decipher and multiparametric MRI on prostatectomy pathology.
This was a retrospective study examining patients at a single institution who underwent Decipher genomic classifier testing on prostate biopsy tissue (n = 888) between December 2016 and March 2023. Data regarding PSA, MRI PIRADS score, biopsy Gleason grade group, Decipher genomic classifier score, and treatment modality were collected. Dr. Sheng and colleagues performed a multivariable ordinal logistic regression model with prostatectomy Gleason grade group upgrading (ie. Gleason grade group increase from biopsy) as the outcome and PSA, biopsy Gleason grade group, Decipher and PIRADS score as potential predictors.
Among 142 patients who underwent radical prostatectomy, the final cohort included 104 patients who had a multiparametric MRI, Gleason grade group 1-3 on biopsy, and Decipher genomic classifier prior to prostatectomy. The following table highlights the characteristics of patients who received radical prostatectomy after initial biopsy:
This study found that Decipher genomic classifier on biopsy was associated with upgrading on prostatectomy Gleason grade group ( (OR 1.27, 95% CI 1.01 – 1.61; p = 0.043). There was no significant association with PIRADS score (p = 0.196), PSA (p = 0.217), or biopsy Gleason grade group 2 compared to Gleason grade group 1 (p = 0.345). As expected, there was a strong association with prostatectomy Gleason grade group upgrading with biopsy Gleason grade group 3 (OR 8.18, 95% CI 2.07 – 34.53; p = 0.003):
Dr. Sheng concluded his presentation by discussing the influence of the Decipher genomic classifier on initial prostate biopsy Gleason Score upgrading on final radical prostatectomy pathology with the following take-home points:
- Tumor based molecular assays such as Decipher genomic classifier are included in the NCCN guidelines for localized prostate cancer management
- Decipher genomic classifier has been shown to independently predict adverse pathology in patients with very low-, low- and intermediate-risk prostate cancer
- This study found that Decipher genomic classifier and unfavorable intermediate risk biopsy are predictors of upgrading on prostatectomy, while multiparametric MRI (PIRADS) and PSA are not
- Future directions include investigating the GRID database to see if there are certain gene expressions or signatures that are associated with Gleason grade group upgrading on final radical prostatectomy pathology
Presented by: John Sheng, MD, Washington University School of Medicine, St. Louis, MO
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2023 Society of Urologic Oncology (SUO) Annual Meeting, Washington, D.C., Tues, Nov 28 – Fri, Dec 1, 2023.