Genomic Prostate Score for Identifying Biologically Low-risk Disease in Patients with Prostate Cancer Undergoing...

Area of Science:

• Oncology
• Genomics
• Urology

Background:

• Validated genomic classifiers are recommended for prostate cancer (PCa) management changes.
• The potential for de-escalation using these classifiers remains unclear.
• The 17-gene Genomic Prostate Score (GPS) is a key genomic classifier.

Purpose of the Study:

• To retrospectively evaluate the 17-gene GPS for management de-escalation in prostate cancer.
• To assess GPS performance against metastasis and high-risk biochemical recurrence (BCR).
• To identify patients with favorable outcomes despite high clinical risk.

Main Methods:

• Retrospective evaluation of 409 patients with localized and locally advanced PCa.
• Patients managed with active surveillance (AS), radical prostatectomy (RP), or radiotherapy (RT).
• Stratification of low GPS score patients into 'concordant' and 'discordant' groups based on NCCN risk categories.

Main Results:

• The 'discordant low-risk' phenotype (high NCCN risk, low GPS) was prevalent (46-57% in various groups).
• Six-year event-free survival was favorable in 'discordant low-risk' patients (88-100%).
• Outcomes were similar to 'concordant low-risk' patients (100% 6-yr treatment-free survival).

Conclusions:

• A prevalent group of prostate cancer patients with high clinical risk but low GPS scores demonstrates favorable outcomes.
• This finding supports the feasibility of using genomic classifiers for targeted management de-escalation.
• Future trials can leverage GPS for de-escalation strategies in prostate cancer management.