Impact of Genomic Classifiers on Risk Stratification and Treatment Intensity in Patients With Localized Prostate Cancer : A Systematic Review

Amir Alishahi Tabriz ¹, Matthew J Boyer ², Adelaide M Gordon ³

¹Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida (A.A.T.).
²Durham VA Health Care System, Durham; and Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina (M.J.B.).
³Durham VA Health Care System, Durham, North Carolina (A.M.G., B.E., M.J.).
⁴Department of Radiation Oncology, Wellstar Paulding Medical Center, Hiram, Georgia (D.J.C.).
⁵Durham VA Health Care System, Durham; and Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina (J.R.G.).
⁶Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina (S.R.R.).
⁷Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah (D.S.).
⁸Division of Urology, Department of Surgery, McGill University, Montreal, Canada (A.R.-B).
⁹Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina (J.L.).
¹⁰Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina (F.B.).
¹¹Durham VA Health Care System, Durham; and Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina (R.L.B.).
¹²Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina (A.S.K.).
¹³Duke University Medical Center Library and Archives, Duke University School of Medicine, Durham, North Carolina (S.C.).
¹⁴Durham VA Health Care System, Durham; and Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham; and Department of Population Health, Duke University School of Medicine, Durham, North Carolina (J.M.G.).
¹⁵Durham VA Health Care System, Durham; and Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina (K.M.G.).

⁰Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida (A.A.T.).

Annals of Internal Medicine +

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January 20, 2025

View abstract on PubMed

Summary

Genomic classifiers (GCs) for prostate cancer (PCa) show varied impacts on risk stratification and treatment decisions. More research is needed to clarify their role in newly diagnosed patients.

Area Of Science

Oncology
Genomics
Clinical Decision-Making

Background

Tissue-based genomic classifiers (GCs) are emerging tools for enhancing prostate cancer (PCa) risk assessment.
These classifiers aim to refine treatment recommendations for localized PCa.

Purpose Of The Study

To evaluate the influence of Decipher, Oncotype DX Genomic Prostate Score (GPS), and Prolaris GCs on risk stratification.
To assess the impact of these GCs on treatment choices for localized PCa patients considering initial treatment.

Main Methods

Systematic review of MEDLINE, EMBASE, and Web of Science databases (January 2010 - August 2024).
Independent study identification and data extraction by two researchers.
Duplicate assessment of risk of bias (ROB) for included studies.

Main Results

Observational studies in low ROB indicated GCs often maintained or lowered risk classification for very low- or low-risk PCa patients.
One randomized trial showed GPS reclassified a significant proportion of very low- and low-risk patients to a higher risk category.
Treatment decisions post-GC testing in observational studies favored active surveillance; however, one randomized trial suggested fewer active surveillance options after GPS testing.

Conclusions

Genomic classifiers (GCs) demonstrate inconsistent effects on risk classification and treatment decisions for prostate cancer.
Discrepancies between observational and randomized study findings underscore the need for robust clinical trials.
Further well-designed trials are essential to elucidate the precise role of GCs in newly diagnosed PCa management.

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