Real-world Utilization of Genomic Prostate Score Assay Among Men With Localized Disease

The 17-gene genomic prostate score (GPS) assay can help physicians with clinical management plans, as well as add complementary information to National Comprehensive Cancer Network (NCCN) risk stratification for patients with localized prostate cancer, according to a real-world analysis presented at the 2024 European Association of Urology Congress.

Although the use of active surveillance (AS) has increased in the United States, it is still underutilized due to inaccuracies of risk assessment tools, misdiagnoses, and the potential of cancer upstaging that could be prevented with definitive therapy (DT).

Steven Canfield, MD, of the University of Texas Health Science Center at Houston, and colleagues designed a retrospective, observational, cohort study that described real-world utilization and patient characteristics of men with GPS-tested prostate cancer through claims and electronic health record (EHR) data. Researchers also assessed the use of AS and DT by patient subgroups based on NCCN risk stratification, race, and GPS results.

A total of 834 men aged 40 to 80 years with claims for localized prostate cancer, continuous enrollment in the Optum Claims dataset, at least 1 day of EHR clinical activity, and GPS results were included in the analysis. Patients were classified as undergoing DT (prostatectomy, radiation, or focal therapy) or AS.

Among the total patient sample, 77.9% (n=650) underwent initial AS and 22.1% (n=184) underwent DT. In both groups, the majority of men had T1c disease.

The most common Gleason pattern in the AS cohort was 3+3 (79.6%) compared with 3+4 (55.9%) in the DT cohort. Dr. Canfield and colleagues noted that the mean GPS at index was 23.2 for men undergoing AS and 30.9 for those undergoing DT.

Furthermore, they found that AS decreased with increasing GPS results and NCCN risk, and differences between races were minimal. In the first 6 months after AS or DT initiation, total costs were significantly higher for patients receiving DT.

“Most men with GPS-tested localized prostate cancer underwent AS, which indicates the GPS result can help physicians on their clinical management plans,” study authors concluded. “Decreasing AS with increasing GPS result and NCCN risk suggests that the GPS adds complementary information to NCCN risk stratification.”