Decipher Genomic Classifier Augments Progression Surveillance for Patients With Prostate Cancer

The addition of a novel genomic classifier (GC) during active surveillance for prostate cancer (PCa) was shown to predict disease progression independently from clinical risk assessment tools such as multiparametric magnetic resonance imaging (mpMRI), according to a recent study presented at the Society of Urologic Oncology (SUO) 25^th Annual Meeting.

Mark I. Sultan, MD, of Mount Sinai West Hospital, New York, presented the findings at the annual meeting. In explaining the study background, the researchers pointed to the fact that more than 27% of newly diagnosed PCa cases are classified as low risk or below by National Comprehensive Cancer Network (NCCN) guidelines. As such, active surveillance (AS) is often used to manage low-risk diagnoses, despite the 20% to 50% risk of PCa progression at five years.

The primary aim of the study was to assess imaging and genomic risk stratification tools upon diagnosis of PCa “with AS clinical progression to treatment.” The researchers also aimed to determine whether the combination of mpMRI and Decipher testing would improve the predictability of disease progression and prognosis.

According to the study methodology, a retrospective review of consecutive patients with AS (n=338), who were identified from biopsies submitted for Decipher GC testing from December 2016 to December 2023, was conducted. At the start of AS, prostate-specific antigen (PSA), index biopsy Gleason Grade Group, NCCN risk group, mpMRI Prostate Imaging-Reporting and Data System (PI-RADS) classification, and Decipher GC score were recorded. Treatment timing was also recorded if disease progressed.

Participants were stratified by PI-RADS 1-3 or 4-5 classification or by Decipher low (<0.45), intermediate (0.45-0.6), or high risk (>0.6). The association of the initial risk assessment of participants to AS outcomes was evaluated via chi-square statistic and “Kendall’s tau-b correlation coefficient evaluated the relationship between Decipher GC (≥0.45) and mpMRI (PI-RADS 4-5).”

Of the 338 patients with AS, 34% experienced disease progression during the median follow-up period of 26 months (IQR 16-40). The mean PSA value among participants was 7.4 ng/mL. The hazard ratio (HR) for Decipher GC ≥0.45 was 2.04 (IQR [1.39-2.99], P<.001) and 1.85 (IQR [1.21-2.81], P=.004) for PI-RADS 4-5.

According to the results, “genomic and imaging high-risk features were weakly correlated” and “Decipher® GC ≥0.45 remained a predictor for all patients.” However, PI-RADS 4-5 was not found to have predictive utility for men with Decipher GC ≥0.45 (HR 1.27, IQR [0.59-2.71]).

The researchers explained that the study found that “elevated risk evaluations” at the start of AS by both Decipher GC (≥0.45) and mpMRI (PI-RADS 4-5) had low association, indicating that imaging and genomic assessments “should ideally be combined” due to both tools offering “distinct, complementary prognostic information.” This was especially evident, given that Decipher GC ≥0.45 and PI-RADS 4-5 correlated with progression to treatment at the start of AS.

The investigators stated that Decipher GC testing improved individualized AS for PCa, concluding that “our results validate a Decipher® GC ≥0.45 as an independent predictor for AS progression in patients across PI-RADS classification, while mpMRI PI-RADS 4-5 was not when Decipher® GC ≥0.45.”

Reference:

Sultan M, McGinnis J, Sheng J, et al. Clinical progression of prostate cancer from active surveillance is predicted by Decipher® genomic classifier score on index biopsy independent from risk assessment by MRI characteristics. Presented at the 25^th Annual Meeting of the Society of Urologic Oncology; December 4-6, 2024; Dallas, Texas.