SAN DIEGO, CA USA (UroToday.com) - A significant number of prostate cancer patients will experience a biochemical recurrence (BCR) after definitive treatment with radical prostatectomy, however not all are destined to develop metastatic disease. Dr. Ashley Ross and colleagues assessed a genomic classifier (Decipher™) in men with BCR for its ability to predict development of clinical metastasis.
The 22-feature genomic classifier (GC) model was validated in a prospectively designed case-cohort study utilizing 1 010 high-risk patients who were treated with radical prostatectomy at the Mayo Clinic. A random sample of 20% from the above population underwent microarray analysis and 219 were assigned a GC score, including those who developed BCR after prostatectomy (N=110). Progression to metastatic disease (documented using CT or bone scan) 3 years after BCR was predicted by GC, yielding a C-index of 0.82 (95% CI 0.80-0.90), which significantly outperformed Gleason score (0.64; 95% CI 0.54-0.69), PSA doubling time (0.60; 95%CI 0.62-0.78), and time to BCR (0.54; 95%CI 0.64-0.81). Similarly, decision curve analysis demonstrated superiority of GC. When stratified by high and low GC scores, incidence of metastases 3 years after BCR was 43% vs. 9%, respectively (p < 0.001). GC remained an independent predictor (p < 0.001) of metastatic potential using multivariable analysis, along with GS (p=0.02).
It appears that GC may enhance patient stratification at the time of BCR and may aid in planning additional therapy. Further validation in other cohorts is needed before applying this approach, with hopes of minimizing overtreatment of those with BCR.
Presented by Ashley E. Ross, Mercedeh Ghadessi, Elai Davicioni, Anamaria Crisan, Christine Buerki, Nicholas Erho, Anirban P. Mitra, Darby J.S. Thompson, Timothy J. Triche, Felix Y. Feng, and Edward M. Schaeffer at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Serge Ginzburg, MD
