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NCCN Risk Reclassification in Black Men with Low and Intermediate Risk Prostate Cancer After Genomic Testing

Published:October 21, 2021DOI:https://doi.org/10.1016/j.urology.2021.08.055

      Highlights

      • The use of genomic testing increased prostate cancer risk designations in an African American cohort
      • OncotypeDX may predict higher risk than do National Comprehensive Cancer Network guidelines
      • Genomic testing may help risk stratify men with low and intermediate risk prostate cancer
      • Genomic testing in men of African descent may better inform prostate cancer treatment plans

      Abstract

      Objectives

      To assess the utility of genomic testing in risk-stratifying Black patients with low and intermediate risk prostate cancer.

      Methods

      We retrospectively identified 63 Black men deemed eligible for active surveillance based on National Comprehensive Cancer Network (NCCN) guidelines, who underwent OncotypeDx Genomic Prostate Score testing between April 2016 and July 2020. Nonparametric statistical testing was used to compare relevant features between patients reclassified to a higher NCCN risk after genomic testing and those who were not reclassified.

      Results

      The median age was 66 years and median pre-biopsy PSA was 7.3. Initial risk classifications were: very low risk: 7 (11.1%), low risk: 24(38.1%), favorable intermediate risk: 31(49.2%), and unfavorable intermediate risk: 1 (1.6%). Overall, NCCN risk classifications after Genomic Prostate Score testing were significantly higher than initial classifications (P=.003, Wilcoxon signed-rank). Among patients with discordant risk designations, 28(28/40, 70%) were reclassified to a higher NCCN risk after genomic testing. A pre-biopsy prostate specific antigen of greater than 10 did not have significantly higher odds of HBR (OR:2.16 [95% CI: 0.64,7.59, P=.2). Of favorable intermediate risk patients, 20(64.5%) were reclassified to a higher NCCN risk. Ultimately, 18 patients underwent definitive treatment.

      Conclusions

      Incorporation of genomic testing in risk stratifying Black men with low and intermediate-risk prostate cancer resulted in overall higher NCCN risk classifications. Our findings suggest a role for increased utilization of genomic testing in refining risk-stratification within this patient population. These tests may better inform treatment decisions on an individualized basis.

      Abbreviations:

      PCa (prostate cancer), AS (active surveillance), NCCN (National Comprehensive Cancer Network), GPS (Genomic Prostate Score), PSA (prostate specific antigen), PSAD (prostate specific antigen density), PIRADS (Prostate Imaging Reporting and Data System), VLR (very low risk), LR (low risk), UIR (unfavorable intermediate risk), FIR (favorable intermediate risk), HR (high risk), DRE (digital rectal exam), RP (radical prostatectomy), RT (radiation therapy), mpMRI (multiparametric magnetic resonance imaging)
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