Genomic test predicts rapid mets in men post-RP

A genomic test for prostate cancer was able to predict rapid metastatic disease in node-negative, high-risk men managed by radical prostatectomy without adjuvant therapy in a recently published study.

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Although rapid metastasis in men treated with radical prostatectomy is relatively uncommon, using tumor genomics to identify these men who have a highly lethal form of metastatic disease is an important advance, researchers say. The study of the Decipher Prostate Cancer Classifier (GenomeDx Biosciences, San Diego) has been published online in European Urology.

The findings highlight the significance of identifying the patients at highest risk of rapid metastasis for timely treatment after surgery, according to a statement from GenomeDx.

Among men who had rapid metastasis within 5 years, while all initially had undetectable PSA after surgery and were indistinguishable by standard clinical and pathologic features, 50% developed bone metastasis by 2 years and 50% died of their disease by 7 years after surgery.

Of men experiencing late metastasis, none died of their prostate cancer at 7 years after surgery, and the median time to metastasis was more than 9 years.

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“Clinical and pathological risk factors were not able to distinguish which among the patients at risk of recurrence in our cohort might develop rapid metastatic disease,” said first author Eric Klein, MD, of the Glickman Urological and Kidney Institute at Cleveland Clinic. “Identification of such patients is clinically relevant, as those at highest risk for rapid metastasis and death are mostly likely to benefit from earlier, more intensive therapy and inclusion in clinical trials of novel agents.

“Perhaps what is more important for the average patient treated with radical prostatectomy at our institution is the high negative predictive value of this genomic test. Our study suggests that a patient with genomic low risk, despite having adverse pathology findings, is likely best managed conservatively after surgery and may safely avoid radiation therapy and the associated adverse side-effects,” Dr. Klein said.

In the study, Dr. Klein and colleagues evaluated 169 patients who had a preoperative PSA of greater than 20.0 ng/mL, a negative pathologic node, undetectable PSA following prostate surgery, and did not have neoadjuvant or adjuvant therapy. Fifteen patients experienced rapid metastasis, defined as occurring within 5 years of surgery, and 34 had late metastasis, defined as occurring more than five years after surgery. When the Decipher results were applied, Decipher demonstrated the highest prediction of metastatic disease compared to the Stephenson and CAPRA-S nomograms, with an area under the curve of 0.77 compared to 0.75 and 0.72 respectively.

In addition, integration of Decipher into the Stephenson nomogram resulted in an increased performance as measured by AUC of 0.79.

Dr. Klein is a paid consultant for GenomeDx Biosciences.

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