Although genomic classifier tests may influence risk classifications or treatment decisions in patients with localized prostate cancer, there is a need for more data to better understand cost effectiveness, clinical utility, and their impact on racial and ethnic groups—particularly Black men, according to a recent study published by Tabriz et al in the Annals of Internal Medicine.
Background
Prostate cancer is the most common cancer type among men, with cases ranging from barely noticeable to highly aggressive and requiring serious treatment. Determining which type of treatment patients need remains a significant challenge.
Traditionally, physicians rely on tools like the NCCN Clinical Practice Guidelines in Oncology, which assess tumor stage, prostate-specific antigen levels, and Gleason grades. Nonetheless, these tools can sometimes lead to overtreatment or undertreatment. Despite tests such as Decipher (Veracyte), Prolaris (Myriad Genetics), and Oncotype DX Genomic Prostate Score (GPS; MDx) offering a genetic snapshot of tumor aggressiveness and potentially identifying details that clinical tools might miss, their use in clinical practice is currently inconsistent as a result of conflicting guidelines.
Study Methods and Results
In the systematic review, investigators analyzed the data from 19 studies to assess the impact of these tissue-based genomic tests on risk stratification and treatment decisions for localized prostate cancer. The investigators examined test type, quality, population characteristics, risk reclassification, and recommended and/or received treatment intensity.
The investigators discovered that in observational studies with a low risk of bias, most of the patients with low or very low baseline risk did not experience an increase in risk classification after genomic classifier testing. However, this pattern differed across genomic classifier test types, with GPS-based studies finding 0% to 11.9% of the patients were reclassified to a higher risk category compared with 12.8% to 17.1% among Decipher-based studies. In a randomized trial, reclassification to higher risk was more prevalent compared with in the observational studies. Observational studies indicated that genomic classifier testing often led to more patients opting for conservative management options, including active surveillance.
Conclusions
The investigators emphasized that the differences in results from observational and randomized trials highlighted the need for well-designed trials evaluating the impact of genomic classifier tests in the management of prostate cancer to more effectively inform patient-clinician decision-making.
Disclosure: For full disclosures of the study authors, visit acpjournals.org.
