Use of the Decipher genomic classifier among men with prostate cancer in the United States

Nicholas G. Zaorsky; James A. Proudfoot; Angela Y. Jia; Raed Zuhour; Randy Vince; Yang Liu; Xin Zhao; Jim Hu; Nicola C. Schussler; Jennifer L. Stevens; Suzanne Bentler; Rosemary D. Cress; Jennifer A. Doherty; Eric B. Durbin; Susan Gershman; Iona Cheng; Lou Gonsalves; Brenda Y. Hernandez; Lihua Liu; Bózena M. Morawski; Maria Schymura; Stephen M. Schwartz; Kevin C. Ward; Charles Wiggins; Xiao Cheng Wu; Jonathan E. Shoag; Lee Ponsky; Alan Dal Pra; Edward M. Schaeffer; Ashley E. Ross; Yilun Sun; Elai Davicioni; Valentina Petkov; Daniel E. Spratt

doi:10.1093/jncics/pkad052

Use of the Decipher genomic classifier among men with prostate cancer in the United States

Nicholas G. Zaorsky, James A. Proudfoot, Angela Y. Jia, Raed Zuhour, Randy Vince, Yang Liu, Xin Zhao, Jim Hu, Nicola C. Schussler, Jennifer L. Stevens, Suzanne Bentler, Rosemary D. Cress, Jennifer A. Doherty, Eric B. Durbin, Susan Gershman, Iona Cheng, Lou Gonsalves, Brenda Y. Hernandez, Lihua Liu, Bózena M. MorawskiMaria Schymura, Stephen M. Schwartz, Kevin C. Ward, Charles Wiggins, Xiao Cheng Wu, Jonathan E. Shoag, Lee Ponsky, Alan Dal Pra, Edward M. Schaeffer, Ashley E. Ross, Yilun Sun, Elai Davicioni, Valentina Petkov, Daniel E. Spratt

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Background: Management of localized or recurrent prostate cancer since the 1990s has been based on risk stratification using clinicopathological variables, including Gleason score, T stage (based on digital rectal exam), and prostate-specific antigen (PSA). In this study a novel prognostic test, the Decipher Prostate Genomic Classifier (GC), was used to stratify risk of prostate cancer progression in a US national database of men with prostate cancer. Methods: Records of prostate cancer cases from participating SEER (Surveillance, Epidemiology, and End Results) program registries, diagnosed during the period from 2010 through 2018, were linked to records of testing with the GC prognostic test. Multivariable analysis was used to quantify the association between GC scores or risk groups and use of definitive local therapy after diagnosis in the GC biopsy-tested cohort and postoperative radiotherapy in the GC-tested cohort as well as adverse pathological findings after prostatectomy. Results: A total of 572 <FOR VERIFICATION>545 patients were included in the analysis, of whom 8927 patients underwent GC testing. GC biopsy-tested patients were more likely to undergo active active surveillance or watchful waiting than untested patients (odds ratio [OR] =2.21, 95% confidence interval [CI] = 2.04 to 2.38, P <. 001). The highest use of active surveillance or watchful waiting was for patients with a low-risk GC classification (41%) compared with those with an intermediate- (27%) or high-risk (11%) GC classification (P <. 001). Among National Comprehensive Cancer Network patients with low and favorable-intermediate risk, higher GC risk class was associated with greater use of local therapy (OR = 4.79, 95% CI = 3.51 to 6.55, P <. 001). Within this subset of patients who were subsequently treated with prostatectomy, high GC risk was associated with harboring adverse pathological findings (OR = 2.94, 95% CI = 1.38 to 6.27, P =. 005). Use of radiation after prostatectomy was statistically significantly associated with higher GC risk groups (OR = 2.69, 95% CI = 1.89 to 3.84). Conclusions: There is a strong association between use of the biopsy GC test and likelihood of conservative management. Higher genomic classifier scores are associated with higher rates of adverse pathology at time of surgery and greater use of postoperative radiotherapy. In this study the Decipher Prostate Genomic Classifier (GC) was used to analyze a US national database of men with prostate cancer. Use of the GC was associated with conservative management (ie, active surveillance). Among men who had high-risk GC scores and then had surgery, there was a 3-fold higher chance of having worrisome findings in surgical specimens.

Original language	English
Article number	pkad052
Journal	JNCI Cancer Spectrum
Volume	7
Issue number	5
DOIs	https://doi.org/10.1093/jncics/pkad052
State	Published - Oct 1 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s).

Funding

The Surveillance, Epidemiology, and End Results Program is funded by the National Cancer Institute. Veracyte performed the work to electronically submit the Decipher score results, but provided no funding for this study. The authors report funding from the following sources: Iowa Cancer Registry, through National Cancer Institute, Surveillance, Epidemiology, and End Results Program Contract Award No. HHSN261201800012I_HHSN26100001 (to SB); Public Health Institute, Cancer Registry of Greater California, through National Cancer Institute, Surveillance, Epidemiology and End Results Program Contract Award No. HHSN261201800009 (to RDC); Hunstman Cancer Institute Cancer Control and Population Sciences Program, through National Cancer Institute, Surveillance, Epidemiology and End Results Program Contract Award HHSN261201800016I (to JAD); Kentucky Cancer Registry, through National Cancer Institute, Surveillance, Epidemiology and End Results Program Contract Award No. HHSN261201800013I (to EBD); Massachusetts cancer registry, MA, through National Cancer Institute, Surveillance, Epidemiology and End Results Program Contract Award No. HHSN26120180008I (HHSN26100001) (to SG); University of California, San Francisco, CA, through National Cancer Institute, Surveillance, Epidemiology and End Results Program Contract Award HHSN261201800032I (to SLG); the Connecticut Tumor Registry, supported by Federal funds from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, under Contract no. HHSN261201800002I (to LG); University of Hawaii Cancer Center, HI, through National Cancer Institute, Surveillance, Epidemiology and End Results Program Contract Award No. HHSN261201300009I (to BYH). Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA. through National Cancer Institute, Surveillance, Epidemiology and End Results Program Contract Award HHSN261201800032I (to LL); Cancer Data Registry of Idaho, Idaho Hospital Association, Boise, Idaho, through National Cancer Institute, Surveillance, Epidemiology and End Results Program Contract Award HHSN261201800006I and Centers for Disease Control and Prevention 1NU58DP006270 (to BMM); Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY, through National Cancer Institute, Surveillance, Epidemiology and End Results Program Contract Award HHSN261201800005I and Centers for Disease Control and Prevention NU58DP006309 (to MS); Division of Public Health Sciences, Fred Hutchinson Cancer Center, through National Cancer Institute, Surveillance, Epidemiology, and End Results Program Contract Award HHSN2612018000041 (to SMS); Emory University, Atlanta, GA, through National Cancer Institute, Surveillance, Epidemiology and End Results Program Contract Award HHSN261201800003I and Centers for Disease Control and Prevention 6NU58DP006352-05-01 (to KCW); Emory University, Atlanta, GA, through National Cancer Institute, Surveillance, Epidemiology and End Results Program Contract Award HHSN261201800014I (to CW); and School of Public Health, Louisiana State University Health New Orleans, through National Cancer Institute, Surveillance, Epidemiology and End Results Program Contract Award HHSN261201800007I/HHSN26100002 (to XW).

Funders	Funder number
Connecticut Tumor Registry
Kentucky Cancer Registry	HHSN26100001, HHSN26120180008I, HHSN261201800013I
National Cancer Institute Surveillance Epidemiology and End Results Program	HHSN261201800009
University of Hawaii Cancer Center	HHSN261201300009I
National Institutes of Health (NIH)
U.S. Department of Health and Human Services	HHSN261201800002I
U.S. Department of Health and Human Services
National Childhood Cancer Registry – National Cancer Institute	HHSN261201800012I_HHSN26100001
National Childhood Cancer Registry – National Cancer Institute
Institute of Public Health
University of California, Los Angeles	HHSN261201800032I
University of California, Los Angeles
Huntsman Cancer Institute, University of Utah	HHSN261201800016I
Huntsman Cancer Institute, University of Utah
Cancer Registry of Greater California

ASJC Scopus subject areas

Oncology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/jncics/pkad052

Cite this

Zaorsky, N. G., Proudfoot, J. A., Jia, A. Y., Zuhour, R., Vince, R., Liu, Y., Zhao, X., Hu, J., Schussler, N. C., Stevens, J. L., Bentler, S., Cress, R. D., Doherty, J. A., Durbin, E. B., Gershman, S., Cheng, I., Gonsalves, L., Hernandez, B. Y., Liu, L., ... Spratt, D. E. (2023). Use of the Decipher genomic classifier among men with prostate cancer in the United States. JNCI Cancer Spectrum, 7(5), Article pkad052. https://doi.org/10.1093/jncics/pkad052

@article{78223451a7cb48d8b0a75ad01095d04f,

title = "Use of the Decipher genomic classifier among men with prostate cancer in the United States",

abstract = "Background: Management of localized or recurrent prostate cancer since the 1990s has been based on risk stratification using clinicopathological variables, including Gleason score, T stage (based on digital rectal exam), and prostate-specific antigen (PSA). In this study a novel prognostic test, the Decipher Prostate Genomic Classifier (GC), was used to stratify risk of prostate cancer progression in a US national database of men with prostate cancer. Methods: Records of prostate cancer cases from participating SEER (Surveillance, Epidemiology, and End Results) program registries, diagnosed during the period from 2010 through 2018, were linked to records of testing with the GC prognostic test. Multivariable analysis was used to quantify the association between GC scores or risk groups and use of definitive local therapy after diagnosis in the GC biopsy-tested cohort and postoperative radiotherapy in the GC-tested cohort as well as adverse pathological findings after prostatectomy. Results: A total of 572 545 patients were included in the analysis, of whom 8927 patients underwent GC testing. GC biopsy-tested patients were more likely to undergo active active surveillance or watchful waiting than untested patients (odds ratio [OR] =2.21, 95\% confidence interval [CI] = 2.04 to 2.38, P <. 001). The highest use of active surveillance or watchful waiting was for patients with a low-risk GC classification (41\%) compared with those with an intermediate- (27\%) or high-risk (11\%) GC classification (P <. 001). Among National Comprehensive Cancer Network patients with low and favorable-intermediate risk, higher GC risk class was associated with greater use of local therapy (OR = 4.79, 95\% CI = 3.51 to 6.55, P <. 001). Within this subset of patients who were subsequently treated with prostatectomy, high GC risk was associated with harboring adverse pathological findings (OR = 2.94, 95\% CI = 1.38 to 6.27, P =. 005). Use of radiation after prostatectomy was statistically significantly associated with higher GC risk groups (OR = 2.69, 95\% CI = 1.89 to 3.84). Conclusions: There is a strong association between use of the biopsy GC test and likelihood of conservative management. Higher genomic classifier scores are associated with higher rates of adverse pathology at time of surgery and greater use of postoperative radiotherapy. In this study the Decipher Prostate Genomic Classifier (GC) was used to analyze a US national database of men with prostate cancer. Use of the GC was associated with conservative management (ie, active surveillance). Among men who had high-risk GC scores and then had surgery, there was a 3-fold higher chance of having worrisome findings in surgical specimens.",

author = "Zaorsky, \{Nicholas G.\} and Proudfoot, \{James A.\} and Jia, \{Angela Y.\} and Raed Zuhour and Randy Vince and Yang Liu and Xin Zhao and Jim Hu and Schussler, \{Nicola C.\} and Stevens, \{Jennifer L.\} and Suzanne Bentler and Cress, \{Rosemary D.\} and Doherty, \{Jennifer A.\} and Durbin, \{Eric B.\} and Susan Gershman and Iona Cheng and Lou Gonsalves and Hernandez, \{Brenda Y.\} and Lihua Liu and Morawski, \{B{\'o}zena M.\} and Maria Schymura and Schwartz, \{Stephen M.\} and Ward, \{Kevin C.\} and Charles Wiggins and Wu, \{Xiao Cheng\} and Shoag, \{Jonathan E.\} and Lee Ponsky and \{Dal Pra\}, Alan and Schaeffer, \{Edward M.\} and Ross, \{Ashley E.\} and Yilun Sun and Elai Davicioni and Valentina Petkov and Spratt, \{Daniel E.\}",

note = "Publisher Copyright: {\textcopyright} 2023 The Author(s).",

year = "2023",

month = oct,

day = "1",

doi = "10.1093/jncics/pkad052",

language = "English",

volume = "7",

number = "5",

}

Zaorsky, NG, Proudfoot, JA, Jia, AY, Zuhour, R, Vince, R, Liu, Y, Zhao, X, Hu, J, Schussler, NC, Stevens, JL, Bentler, S, Cress, RD, Doherty, JA, Durbin, EB, Gershman, S, Cheng, I, Gonsalves, L, Hernandez, BY, Liu, L, Morawski, BM, Schymura, M, Schwartz, SM, Ward, KC, Wiggins, C, Wu, XC, Shoag, JE, Ponsky, L, Dal Pra, A, Schaeffer, EM, Ross, AE, Sun, Y, Davicioni, E, Petkov, V & Spratt, DE 2023, 'Use of the Decipher genomic classifier among men with prostate cancer in the United States', JNCI Cancer Spectrum, vol. 7, no. 5, pkad052. https://doi.org/10.1093/jncics/pkad052

TY - JOUR

T1 - Use of the Decipher genomic classifier among men with prostate cancer in the United States

AU - Zaorsky, Nicholas G.

AU - Proudfoot, James A.

AU - Jia, Angela Y.

AU - Zuhour, Raed

AU - Vince, Randy

AU - Liu, Yang

AU - Zhao, Xin

AU - Hu, Jim

AU - Schussler, Nicola C.

AU - Stevens, Jennifer L.

AU - Bentler, Suzanne

AU - Cress, Rosemary D.

AU - Doherty, Jennifer A.

AU - Durbin, Eric B.

AU - Gershman, Susan

AU - Cheng, Iona

AU - Gonsalves, Lou

AU - Hernandez, Brenda Y.

AU - Liu, Lihua

AU - Morawski, Bózena M.

AU - Schymura, Maria

AU - Schwartz, Stephen M.

AU - Ward, Kevin C.

AU - Wiggins, Charles

AU - Wu, Xiao Cheng

AU - Shoag, Jonathan E.

AU - Ponsky, Lee

AU - Dal Pra, Alan

AU - Schaeffer, Edward M.

AU - Ross, Ashley E.

AU - Sun, Yilun

AU - Davicioni, Elai

AU - Petkov, Valentina

AU - Spratt, Daniel E.

PY - 2023/10/1

Y1 - 2023/10/1

N2 - Background: Management of localized or recurrent prostate cancer since the 1990s has been based on risk stratification using clinicopathological variables, including Gleason score, T stage (based on digital rectal exam), and prostate-specific antigen (PSA). In this study a novel prognostic test, the Decipher Prostate Genomic Classifier (GC), was used to stratify risk of prostate cancer progression in a US national database of men with prostate cancer. Methods: Records of prostate cancer cases from participating SEER (Surveillance, Epidemiology, and End Results) program registries, diagnosed during the period from 2010 through 2018, were linked to records of testing with the GC prognostic test. Multivariable analysis was used to quantify the association between GC scores or risk groups and use of definitive local therapy after diagnosis in the GC biopsy-tested cohort and postoperative radiotherapy in the GC-tested cohort as well as adverse pathological findings after prostatectomy. Results: A total of 572 545 patients were included in the analysis, of whom 8927 patients underwent GC testing. GC biopsy-tested patients were more likely to undergo active active surveillance or watchful waiting than untested patients (odds ratio [OR] =2.21, 95% confidence interval [CI] = 2.04 to 2.38, P <. 001). The highest use of active surveillance or watchful waiting was for patients with a low-risk GC classification (41%) compared with those with an intermediate- (27%) or high-risk (11%) GC classification (P <. 001). Among National Comprehensive Cancer Network patients with low and favorable-intermediate risk, higher GC risk class was associated with greater use of local therapy (OR = 4.79, 95% CI = 3.51 to 6.55, P <. 001). Within this subset of patients who were subsequently treated with prostatectomy, high GC risk was associated with harboring adverse pathological findings (OR = 2.94, 95% CI = 1.38 to 6.27, P =. 005). Use of radiation after prostatectomy was statistically significantly associated with higher GC risk groups (OR = 2.69, 95% CI = 1.89 to 3.84). Conclusions: There is a strong association between use of the biopsy GC test and likelihood of conservative management. Higher genomic classifier scores are associated with higher rates of adverse pathology at time of surgery and greater use of postoperative radiotherapy. In this study the Decipher Prostate Genomic Classifier (GC) was used to analyze a US national database of men with prostate cancer. Use of the GC was associated with conservative management (ie, active surveillance). Among men who had high-risk GC scores and then had surgery, there was a 3-fold higher chance of having worrisome findings in surgical specimens.

AB - Background: Management of localized or recurrent prostate cancer since the 1990s has been based on risk stratification using clinicopathological variables, including Gleason score, T stage (based on digital rectal exam), and prostate-specific antigen (PSA). In this study a novel prognostic test, the Decipher Prostate Genomic Classifier (GC), was used to stratify risk of prostate cancer progression in a US national database of men with prostate cancer. Methods: Records of prostate cancer cases from participating SEER (Surveillance, Epidemiology, and End Results) program registries, diagnosed during the period from 2010 through 2018, were linked to records of testing with the GC prognostic test. Multivariable analysis was used to quantify the association between GC scores or risk groups and use of definitive local therapy after diagnosis in the GC biopsy-tested cohort and postoperative radiotherapy in the GC-tested cohort as well as adverse pathological findings after prostatectomy. Results: A total of 572 545 patients were included in the analysis, of whom 8927 patients underwent GC testing. GC biopsy-tested patients were more likely to undergo active active surveillance or watchful waiting than untested patients (odds ratio [OR] =2.21, 95% confidence interval [CI] = 2.04 to 2.38, P <. 001). The highest use of active surveillance or watchful waiting was for patients with a low-risk GC classification (41%) compared with those with an intermediate- (27%) or high-risk (11%) GC classification (P <. 001). Among National Comprehensive Cancer Network patients with low and favorable-intermediate risk, higher GC risk class was associated with greater use of local therapy (OR = 4.79, 95% CI = 3.51 to 6.55, P <. 001). Within this subset of patients who were subsequently treated with prostatectomy, high GC risk was associated with harboring adverse pathological findings (OR = 2.94, 95% CI = 1.38 to 6.27, P =. 005). Use of radiation after prostatectomy was statistically significantly associated with higher GC risk groups (OR = 2.69, 95% CI = 1.89 to 3.84). Conclusions: There is a strong association between use of the biopsy GC test and likelihood of conservative management. Higher genomic classifier scores are associated with higher rates of adverse pathology at time of surgery and greater use of postoperative radiotherapy. In this study the Decipher Prostate Genomic Classifier (GC) was used to analyze a US national database of men with prostate cancer. Use of the GC was associated with conservative management (ie, active surveillance). Among men who had high-risk GC scores and then had surgery, there was a 3-fold higher chance of having worrisome findings in surgical specimens.

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Use of the Decipher genomic classifier among men with prostate cancer in the United States

Abstract

Bibliographical note

Funding

ASJC Scopus subject areas

UN SDGs

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