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A High Decipher Genomic Risk Score Is Associated with Major Pathological Progression in Patients Undergoing Active

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Genomic Decipher scores predict major upgrading and unfavorable histology in men on active surveillance for prostate cancer. Lower Decipher scores may support deintensification of monitoring for favorable-risk disease.

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Area of Science:

  • Oncology
  • Genomics
  • Urology

Background:

  • Active surveillance (AS) is standard for favorable-risk prostate cancer.
  • Genomic testing's role in AS outcomes is understudied.
  • Decipher scores assess genomic risk in prostate cancer.

Purpose of the Study:

  • To investigate the association between Decipher genomic scores and AS outcomes.
  • To determine if Decipher scores predict disease progression during AS.
  • To inform clinical decision-making for men with prostate cancer on AS.

Main Methods:

  • Retrospective cohort study of 486 men on AS with Decipher testing.
  • Primary outcomes: any upgrading, major upgrading (GG≥3), and unfavorable histology on subsequent biopsy.
  • Multivariable Cox regression models adjusted for CAPRA scores and clinicodemographic variables.

Main Results:

  • Decipher scores were associated with major upgrading (HR 3.37) and unfavorable histology (HR 3.68) after adjusting for CAPRA scores.
  • High Decipher risk independently predicted major upgrading (HR 2.00-2.65) and unfavorable histology (HR 4.53).
  • No association found between Decipher scores and any upgrading; lower Decipher scores may indicate suitability for surveillance deintensification.

Conclusions:

  • Decipher genomic scores are associated with adverse pathology outcomes in men on active surveillance for prostate cancer.
  • Genomic testing can refine risk stratification beyond traditional methods like CAPRA.
  • Lower Decipher scores may allow for deintensification of active surveillance, reducing unnecessary interventions.