Prostate Cancer: Are Genomic Tests the Future of Risk Assessment?

Genomic tests show potential in prostate cancer treatment decisions, but more data is needed on their effectiveness and impact on diverse populations.

A systematic review concluded that while genomic classifier (GC) tests could affect risk classifications or treatment choices for patients with localized prostate cancer (PCa), more research is needed on their cost-effectiveness, clinical utility, and their effects on racial and ethnic groups, especially Black men. The study was published in the Annals of Internal Medicine ().

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Challenges in Determining the Right Prostate Cancer Treatment

Prostate cancer is the most common cancer among men, with cases ranging from barely noticeable to highly aggressive ones requiring serious treatment. Determining who needs which type of treatment remains a significant challenge. Traditionally, clinicians rely on tools like the NCCN guidelines, which assess tumor stage, PSA levels, and Gleason grades. However, these tools are not perfect and can sometimes lead to overtreatment or undertreatment.

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Genomic Tests for Tumor Aggressiveness in Prostate Cancer

Tests like Decipher by Veracyte, Prolaris by Myriad Genetics, and Oncotype DX Genomic Prostate Score (GPS) by MDx offer a genetic snapshot of tumor aggressiveness, potentially catching things that clinical tools might miss. Despite the potential of these tests, their use in clinical practice is inconsistent due to conflicting guidelines.

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Impact of Genomic Testing on Treatment Decisions

Researchers from the Department of Veterans Affairs reviewed 19 studies to assess the impact of these tissue-based genomic tests on risk stratification and treatment decisions for localized prostate cancer. The researchers analyzed test type, quality, population characteristics, risk reclassification and recommended and/or received treatment intensity and found that in low risk of bias observational studies, most patients with low or very low baseline risk did not see an increase in risk classification after GC testing.

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Variation in Risk Reclassification Across Genomic Test Types

This pattern differed across GC test types, however, with GPS-based studies finding 0% - 11.9% of patients were reclassified to a higher risk category versus Decipher-based studies finding 12.8% to 17.1% reclassified to a higher risk category. In a randomized trial, reclassification to higher risk was more prevalent than in the observational studies examined. Observational studies indicated that GC testing often led to more patients opting for conservative management options like active surveillance.

Need for Well-Designed Trials on Genomic Tests in Prostate Cancer

The researchers note that the differences in results from observational and randomized trials emphasize the need for well-designed trials evaluating the impact of GC tests in management of PCa to inform patient-clinician decision-making.

Reference:

Impact of Genomic Classifiers on Risk Stratification and Treatment Intensity in Patients With Localized Prostate Cancer: A Systematic Review - (https://www.acpjournals.org/doi/10.7326/ANNALS-24-00700)

Source-Eurekalert