Decipher Scores Help Predict Upgrade on PCa Active Surveillance

News

The study was published as a preprint on medrxiv.org and has not yet been peer reviewed.

Key Takeaway

  • Decipher test scores are independently associated with biopsy upgrades in men on active surveillance for Gleason grade group 1 prostate cancer.

  • Higher Decipher scores on the initial test are associated with a greater risk of developing higher-grade disease over time.

  • Incorporating Decipher scores modestly improves risk-prediction based on conventional clinical factors.

Why This Matters

  • Estimating the risk of disease reclassification during active surveillance is imperfect, leading to patient anxiety, avoidable treatment, and overuse or underuse of surveillance testing.

  • The Decipher prognostic tool can help tailor monitoring strategies, such as increasing surveillance in patients at higher risk for progression.

Study Design

  • The researchers retrospectively evaluated whether the initial Decipher scores for 133 men on active surveillance were correlated with the incidence of Gleason grade group upgrade over time.

  • Median patient age was 67.7 years, and median PSA was 5.6 ng/mL.

  • Three quarters of the men were in grade group 1 at enrollment; the rest were in grade group 2.

Key Results

  • Overall, 43 men had a biopsy upgrade with a median interval between biopsies of 13.6 months.

  • A patient’s initial Decipher score was significantly associated with subsequent upgrade (odds ratio, 1.37 per 0.10-unit increase; P = .02).

  • The Decipher score was associated with upgrade in grade group 1 but not grade group 2 disease.

  • A Decipher cutoff score of 0.475 — over a range of 0 to 1 — maximized sensitivity and specificity when predicting biopsy upgrade for men active surveillance. Values above this threshold were associated with almost fourfold higher odds of upgrade.

  • Incorporating the Decipher score into the risk prediction model increased the area under the curve from 0.63 to 0.69.

Limitations

  • Patients selected for Decipher testing may have favored those at higher risk for disease reclassification.

  • The PRECISE criteria for predicting MRI progression were not applied.

  • Follow-up was insufficient to assess long-term outcomes.

Disclosures

  • There was no funding for the study.

  • Three authors disclosed personal fees, equity interest, or consultancy work for a number of companies, including Astellas, AbbVie, Gilead, and Janssen.

This is a summary of a preprint research study, “Association Between a 22-Feature Genomic Classifier and Biopsy Gleason Upgrade During Active Surveillance for Prostate Cancer.” The study has not been peer reviewed. The full text can be found at medrxiv.org.

M. Alexander Otto is a physician assistant with a master’s degree in medical science. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape and is an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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