Investigating the use of genomic classifier testing in prostate cancer risk stratification

Investigating the use of genomic classifier testing in prostate cancer risk stratification

A systematic review found that genomic classifier (GC) testing can influence risk classifications or treatment decisions for patients with localized prostate cancer (PCA), but there is a need for better data on their cost-effectiveness, clinical utility, and impact on racial and ethnic groups, particularly black men. The study is published inAnnals of Internal Medicine.

Prostate cancer is the most common cancer in men, with cases ranging from barely noticeable to highly aggressive that requires serious treatment. Determining who needs this type of treatment remains a significant challenge. Traditionally, physicians rely on tools such as NCCN guidelines that assess tumor stage, PSA levels, and Gleason grades. However, these tools are not perfect and can sometimes lead to overtreatment or undertreatment. Tests like Decipher by Veracyte, Prolaris by Countless Genetics, and MDX's Oncotype Genome Prostatus Score (GPS) provide a genetic snapshot of tumor aggressiveness and may catch things that clinical tools may miss. Despite the potential of these tests, their use in clinical practice is inconsistent due to conflicting guidelines.

Researchers at the Department of Veterans Affairs examined 19 studies to evaluate the impact of these tissue-based genomic tests on risk stratification and treatment decisions for localized prostate cancer. Researchers analyzed test type, quality, population characteristics, risk reclassification, and recommended and/or received treatment intensity GC testing. However, this pattern differed across GC test types, with GPS-based studies finding 0%-11.9% of patients were reclassified into a higher risk category compared to Decipher-based studies finding 12.8% to 17.1% of patients were reclassified into a higher risk category. Reclassification to higher risk was more common in a randomized trial than in the observational studies examined. Observational studies showed that GC testing often resulted in more patients choosing conservative management options such as active surveillance.

The researchers note that the differences in results between observational and randomized studies underscore the need for well-designed studies to evaluate the impact of GC testing on the treatment of PCA to inform decision-making by patient clinicians.

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