Clinical Utility of a Genomic Classifier in Men Undergoing Radical Prostatectomy: The PRO-IMPACT Trial

John L. Gore, Marguerite du Plessis, Jingbin Zhang, Darlene Dai, Darby J.S. Thompson, Lawrence Karsh, Brian Lane, Michael Franks, David Y.T. Chen, Fernando J. Bianco, Gordon Brown, William Clark, Adam S. Kibel, Hyung Kim, William Lowrance, Murugesan Manoharan, Paul Maroni, Scott Perrapato, Paul Sieber, Edouard J. TrabulsiRobert Waterhouse, Daniel E. Spratt, Elai Davicioni, Yair Lotan, Daniel W. Lin

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Purpose: The optimal management of men with prostate cancer at high risk of recurrence postradical prostatectomy is controversial. The clinical utility of the Decipher test was evaluated prospectively on postoperative treatment decisions and patient-reported outcomes. Methods and Materials: In the study, 246 eligible men across 19 centers were enrolled. Patients were dichotomized into those considering adjuvant or salvage radiation therapy (ART or SRT). Participating providers submitted a management recommendation before and after receiving the Decipher test results. Treatment received within 12 months and a validated survey on prostate cancer–related anxiety were collected longitudinally. Results: Pre-Decipher, treatment was recommended for 12% and 40% for the ART and SRT arms, respectively. Post-Decipher, 17% and 30% of treatment recommendations changed in the ART and SRT arms, respectively. Post-Decipher treatment recommendation was administered 78% and 76% of the time in the ART and SRT arms, respectively. Multivariable analysis confirmed that the Decipher score was an independent predictor for change in management for both adjuvant and salvage patients. The number needed to test to change management for one patient was 4. Cancer-specific anxiety decreased among Decipher risk categories in both arms. Conclusions: Use of Decipher postradical prostatectomy test was associated with postoperative treatment decisions. Overall, high Decipher risk was associated with an increase in treatment intensity whereas low risk scores were associated with a decrease in therapy administered independent of clinical and pathologic risk factors.

Original languageEnglish (US)
Pages (from-to)e82-e90
JournalPractical Radiation Oncology
Volume10
Issue number2
DOIs
StatePublished - Mar 1 2020

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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    Gore, J. L., du Plessis, M., Zhang, J., Dai, D., Thompson, D. J. S., Karsh, L., Lane, B., Franks, M., Chen, D. Y. T., Bianco, F. J., Brown, G., Clark, W., Kibel, A. S., Kim, H., Lowrance, W., Manoharan, M., Maroni, P., Perrapato, S., Sieber, P., ... Lin, D. W. (2020). Clinical Utility of a Genomic Classifier in Men Undergoing Radical Prostatectomy: The PRO-IMPACT Trial. Practical Radiation Oncology, 10(2), e82-e90. https://doi.org/10.1016/j.prro.2019.09.016