Test significantly impacts prostate Ca Tx recommendations

A new study assesses how a biopsy-based gene test impacts prostate cancer treatment recommendations in three high-volume practices.

A biopsy-based, 17-gene test (Oncotype DX prostate cancer test, Genomic Health) influences urologists’ treatment recommendations and boosts their confidence for making recommendations to patients with very low to low-intermediate-risk prostate cancer, according to a recently published prospective study.

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The study appears online in Urology Practice (April 10, 2015).

Researchers assessed how incorporating the test, the result of which is expressed as the Genomic Prostate Score (GPS), would impact treatment recommendations in three high-volume urology practices. They studied a total of 158 men, total-35 with very low, 71 with low, and 52 with low-intermediate risk at the time of diagnosis based on National Comprehensive Cancer Network (NCCN) criteria.

They found GPS-predicted biological risk differed from NCCN-based clinical risk alone in 62 men, or 39% of the study population. Use of the GPS prompted urologists to change their recommendations between active surveillance and intermediate treatment in 18% of cases and increased the pool of men recommended active surveillance by 24%. Urologists' recommendations for active surveillance increased 24%.

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And, overall, in 26% of cases, recommended treatment modality and/or intensity of treatment changed post-GPS. Of those patients, use of GPS resulted in an increased intensity treatment in 14 men and decreased intensity treatment in 25 men.

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The most notable frequent recommendation change occurred in the NCCN low-risk group, at 37% after GPS.

“In 17 of 57 men (30%) the initial recommendation of radical prostatectomy was changed to active surveillance after GPS,” the study authors wrote. “Urologists indicated greater confidence and found that incorporating GPS was useful in 85% and 79% of cases, respectively, including when biological risk confirmed the clinical risk category.”

Ketan K. Badani, MD, who led the study while at Columbia University, New York, told Urology Times that personalized risk assessment is going to play a major role in the complex patient-physician decision making process for low-risk prostate cancer.

"This study demonstrates that genomic information provided by Oncotype DX goes beyond standard clinical and pathologic parameters and plays an important role in that process, assessing or estimating risk. And even early in the experience, urologists are finding value and impacting treatment recommendations based on the refined risk assessment," said Dr.Badani, who is now at Mount Sinai Health System, New York.

Dr. Badani has a financial interest in Genomic Health.

A video illustrating how the Oncotype DX test works is available here.