Study highlights potential of genomic tests for early stage prostate cancer

A new review led by researchers at Moffitt Cancer Center assessed how three genomic tests - Decipher, Oncotype DX Genomic Prostate Score (GPS) and Prolaris - can help doctors make better decisions about how to treat patients with early stage prostate cancer. The review, published in the Annals of Internal Medicine, shows that these tests can provide more detailed information about the cancer, but experts say more data is needed on the cost-effectiveness and clinical utility of these tests, as well as their impact on racial and ethnic groups, especially Black men. The review is part of a larger project from the U.S. Department of Veterans Affairs studying genomic classifier testing for prostate cancer.

Prostate cancer is one of the most common types of cancer in men. Doctors often use tests like prostate-specific antigen levels and Gleason scores to help decide how to treat it. Genomic tests look at the genes of the cancer cells, which can give doctors a better idea of how aggressive the cancer might be. This review examines how these tests can help doctors decide the best treatment options for patients.

What the study found:

Better risk assessment: The review showed that genomic tests helped doctors better understand how aggressive the disease is in patients with low-risk prostate cancer. For example:

• Observational studies with low bias showed most patients with very low or low baseline risk retained their risk category, though reclassification rates varied by test: 88.1%-100% for GPS, 82.9%-87.2% for Decipher and 76.9% for Prolaris. A randomized trial, however, reported higher reclassification rates to elevated risk categories (34.5% for very low risk and 29.4% for low risk with GPS).
• For intermediate-risk patients, upward or downward reclassification depended on the genomic test. GPS studies reported minimal upward reclassification (0%-1.7%) but higher rates of downward reclassification (3.8%-28.8%). Decipher and Prolaris studies showed more substantial risk reclassification in both directions.
• Race also influenced reclassification patterns, with differences observed in Black and white men. Treatment decisions after testing often shifted toward active surveillance in observational studies, while randomized trials found GPS testing slightly increased preferences for removal of a cancerous prostate gland or radiation.

Genomic tests give us a clearer picture of how aggressive prostate cancer might be. While these tests show promise, we need more well-designed studies to see exactly how they can improve treatment for patients. This is an exciting area of research for the future of cancer care."

Amir Alishahi Tabriz, M.D., Ph.D., assistant member in the Department of Health Outcomes and Behavior at Moffitt and lead author of the review

This review highlights that genomic tests can improve how doctors assess prostate cancer risk, but they don't always lead to major changes in treatment decisions. The study points out that more research is needed to understand exactly how these tests should be used in clinical practice.

This review was supported by the U.S. Department of Veterans Affairs (PROSPERO: CRD42022347950).