Role of prostate cancer genomics is evolving

Compelling preliminary evidence supports the use of genomics to inform clinical decision-making for the management of prostate cancer. A genome-wide RNA array could serve as an independent prognostic predictor of oncological outcomes.

Dr Ashley Ross (Feinberg School of Medicine, Northwestern University, Chicago, USA) reviewed outcomes of interventions in prostate cancer that considered the Genomic Classifier (GC) score of participants [1]. The Decipher test is a genome-wide RNA expression array that yields a GC score based on 22 genes associated with oncologic pathways. It has been highly validated and is widely available. The GC score ranges from 0–1, with a score of 0–0.45 representing a low risk of clinical progression and a score of 0.60–1.0 representing a high risk of clinical progression.

Dr Ross suggested that the 22-gene GC was an independent prognostic predictor of clinical outcomes following prostatectomy. Dr Ross further demonstrated that adjuvant radiation (defined as radiation administered before reaching a prostate-specific antigen [PSA] value of 0.1 ng/mL) can be considered for patients with >1 of the following risk factors: seminal vesicle invasion, microscopic lymph node involvement, a high Gleason grade group, or a high GC score (i.e. >0.60).

Finally, men who have a low GC score (i.e. <0.45) and receive early salvage radiation should consider the omission of androgen deprivation therapy, as analyses have demonstrated only minimal effect on distant metastases and cancer-specific mortality, and decreased overall survival in these situations. However, in men with intermediate or high GC scores receiving early salvage radiation therapy, all 3 of these parameters were improved.

1. Ross A. Use of Genomics to Guide Treatment Decisions in Post-prostatectomy Patients. ASCO Genitourinary Cancers Symposium, 11–13 February 2021.

 

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Posted on 24 March 202117 May 2024