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Updated: Jun 1, 2025
Microarray-based Identification of Individual HERV Loci Expression: Application to Biomarker Discovery in Prostate Cancer
Published on: November 2, 2013
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.).
Background:
Tissue-based genomic classifiers (GCs) have been developed to improve prostate cancer (PCa) risk assessment and treatment recommendations.
Purpose:
To summarize the impact of the Decipher, Oncotype DX Genomic Prostate Score (GPS), and Prolaris GCs on risk stratification and patient-clinician decisions on treatment choice among patients with localized PCa considering first-line treatment.
Data Sources:
MEDLINE, EMBASE, and Web of Science published from January 2010 to August 2024.
Study Selection:
Two investigators independently identified studies on risk classification and treatment choice after GC testing for patients with localized PCa considering first-line treatment.
Data Extraction:
Relevant data extracted by 1 researcher and overread by a second. Risk of bias (ROB) was assessed in duplicate.
Data Synthesis:
Ten studies reported risk reclassification after GC testing. In low ROB observational studies, very low- or low-risk patients with PCa were more likely to have their risk levels classified as the same or lower (GPS, 100% to 88.1%; Decipher, 87.2% to 82.9%; Prolaris, 76.9%). However, 1 randomized trial found that GC testing with GPS reclassified 34.5% of very low-risk and 29.4% of low-risk patients to a higher risk category. Twelve observational studies indicated that treatment decisions after GC testing either remained unchanged or slightly favored active surveillance. In contrast, analyses from a single randomized trial found fewer choices for active surveillance after GPS testing.
Limitations:
Heterogeneity in screening patterns, risk-determination cutoffs, pathology, and clinical practices. Studies on treatment choice were moderate to high ROB.
Conclusion:
Although GC tests do not consistently influence risk classification or treatment decisions, the differences observed between observational and randomized studies highlight a need for well-designed trials to explore the role of GC tests in patients with newly diagnosed PCa considering first-line treatment.
Primary Funding Source:
U.S. Department of Veterans Affairs. (PROSPERO: CRD42022347950).
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