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Updated: Jun 1, 2025

Microarray-based Identification of Individual HERV Loci Expression: Application to Biomarker Discovery in Prostate Cancer
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Impact of Genomic Classifiers on Risk Stratification and Treatment Intensity in Patients With Localized Prostate

Amir Alishahi Tabriz1, Matthew J Boyer2, Adelaide M Gordon3

  • 1Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida (A.A.T.).

Annals of Internal Medicine
|January 20, 2025
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.

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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.