Impact of Gene Expression Classifier Testing on Adjuvant Treatment Following Radical Prostatectomy: The G-MINOR...

Area of Science:

• Urology
• Genomics
• Oncology

Background:

• Decipher is a validated genomic classifier (GC) for predicting metastasis after radical prostatectomy (RP).
• A prospective trial assessed the impact of GC-guided care on adjuvant treatment decisions post-RP.

Purpose of the Study:

• To evaluate the impact of Decipher genomic classifier (GC) testing on adjuvant treatment decisions after radical prostatectomy (RP).
• To assess the influence of GC results on treatment choices in patients with high-risk prostate cancer.

Main Methods:

• A prospective randomized controlled cluster-crossover trial design was employed.
• Centers alternated between GC-informed care and usual care (UC) over 3-month periods.
• Patients with pT3-4 disease or positive margins and PSA <0.1 ng/mL were included.

Main Results:

• No significant difference in adjuvant treatment rates between GC-informed care and UC (9.7% vs. 8.7%).
• Higher GC scores showed a non-significant trend towards increased adjuvant treatment (OR=1.35).
• High GC risk groups significantly increased odds of adjuvant treatment compared to low GC risk (OR=6.9, p=0.005), adjusted for CAPRA-S.

Conclusions:

• Genomic classifier (GC) testing influences adjuvant therapy decisions when interpreted using risk categories.
• The study did not find definitive evidence supporting GC testing for adjuvant treatment benefits in prostate cancer.
• No differences in patient-reported urinary or sexual function were observed between arms.