Genomic test shows prognostic value for prostate cancer progression

A series of real-world studies presented at the 24th Annual Meeting of the Society of Urologic Oncology (SUO) highlight the clinical utility of the Decipher Prostate Genomic Classifier (GC) in predicting prostate cancer progression, according to a news release by Veracyte, the developer of the test.¹

"The data presented at SUO 2023 show how users of our test, conducting prospective research on their own patients, affirm the utility of Decipher in real-world settings," says Elai Davicioni, PhD.

Investigators from the Washington University School of Medicine in St. Louis, Missouri presented data from 2 separate studies on a cohort of 888 men with prostate cancer who underwent Decipher testing between December 2016 and March 2023.^2,3

The first study assessed a subset of patients (n = 235) who were initially placed on active surveillance. Of these, 88 patients progressed to treatment. Prostate-specific antigen (PSA) level, PI-RADS score, and Decipher were all assessed as potential predictors for progression. The investigators found that a Decipher GC score above 0.4 (P = .002) and 0.6 (P = .006) was associated with progression, whereas PI-RADS 3 lesions (P = .92) and a PI-RADS 4-5 lesions (P = .05) were not.²

The second study included patients who had a multiparametric MRI (mpMRI) result, were Gleason Grade Group (GGG) 1-3 on biopsy, and underwent Decipher testing prior to radical prostatectomy to determine the best predictor of final pathology following surgery. Overall, the investigators found Decipher scores to be strongly associated with upgrading on prostatectomy (P = .043), whereas PSA (P = .217), Gleason score (GGG2 vs GGG1; P = .345), and mpMRI (P = .196) were not.³

Eric Kim, MD, an associate professor of surgery at the Washington University School of Medicine and the senior author of both studies, commented in the news release, “Accurately predicting disease progression in patients with prostate cancer is essential so they can receive the treatment that is best suited for them. Our studies consistently demonstrated that data from the Decipher Prostate Genomic Classifier was more reliably predictive of prostate cancer progression and underlying pathology than any other clinical data available, including MRI.”¹

Another study, conducted by investigators at the University of Miami, utilized data from the ongoing Miami MAST trial (NCT02242773). For the study, 224 baseline samples from 124 patients were included for analysis. Decipher scores were found to be associated with grade progression (P = .0005), but not volume progression (P = .92), of prostate cancer compared with patients who did not experience progression.⁴

Further, data from a large-scale, population-based study from investigators at the University of Michigan were also presented at the meeting. The study included over 52,000 patients with prostate cancer who underwent Decipher testing, which was used to determine genomic risk distribution among 2 prospective population-based registries. The primary end point was prostate cancer-specific mortality (PCSM), and the second end point was distant metastasis (DM).

Overall, the investigators found wide variation in genomic risk distribution across clinical stage groups. PCSM (0.1% to 49.2%) and DM (0.3%-73.4%) estimates also varied by clinical-genomic risk. Risk estimates from STAR-CAP were combined with Decipher scores, which led to 25.6% upstaging or 45.5% downstaging of at least 1 stage. The Decipher-informed system also led to a reclassification of at least 2 stages for 7.2% upstaging and 11.8% downstaging. The investigators concluded that genomic and clinicopathologic risk groups may better enhance prediction of clinical outcomes. ⁵

Elai Davicioni, PhD, Veracyte’s medical director for urology, further concluded in the news release, “We developed the Decipher Prostate Genomic Classifier to provide actionable information that helps guide patient care. The data presented at SUO 2023 show how users of our test, conducting prospective research on their own patients, affirm the utility of Decipher in real-world settings. This real-world evidence and scientific research conducted by Decipher users shows how physicians can refine their surveillance or treatment plans based on a more comprehensive view of each patient’s cancer. We are very grateful for the work conducted by these clinician-scientists on behalf of the entire prostate cancer research community.”¹

References

1. Real-world data presented at SUO 2023 show that Veracyte’s Decipher Genomic Classifier identifies patients whose prostate cancer is likely to progress. News release. Veracyte, Inc. December 1, 2023. Accessed December 11, 2023. https://www.businesswire.com/news/home/20231201811059/en/Real-World-Data-Presented-at-SUO-2023-Show-that-Veracyte%E2%80%99s-Decipher-Genomic-Classifier-Identifies-Patients-Whose-Prostate-Cancer-is-Likely-to-Progress

2. Sheng J, Vetter J, Barashi N, McGinnis JR, Kim E. Decipher Genomic Classifier score on initial biopsy is associated with progression from active surveillance to treatment in prostate cancer. Presented at: 2023 Society of Urologic Oncology Annual Meeting. November 28 – December 1, 2023; Washington, DC. Abstract 237

3. Sheng J, Vetter J, Barashi N, McGinnis JR, Kim E. Decipher Genomic Classifier on initial prostate biopsy is associated with Gleason score upgrading on final radical prostatectomy pathology. Presented at: 2023 Society of Urologic Oncology Annual Meeting. November 28 – December 1, 2023; Washington, DC. Abstract 226

4. Khandekar A, Soodana-Prakash N, Han S, et al. Grade and volume progression and its association with the Decipher Genomic Classifier using patients enrolled in a prospective active surveillance protocol. Presented at: 2023 Society of Urologic Oncology Annual Meeting. November 28 – December 1, 2023; Washington, DC. Abstract 219

5. Singhal U, Jiang R, Schipper M, et al. Understanding population-wide genomic risk distribution and integrating clinical genomic risk for prognostication in patients with clinically localized prostate cancer. Presented at: 2023 Society of Urologic Oncology Annual Meeting. November 28 – December 1, 2023; Washington, DC. Abstract 200