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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 21, 2021
Accepted:
August 11,
2021
Received:
February 16,
2021
Footnotes
Disclosures: No author has financial interest or affiliation concerning material discussed in this original article
Identification
Copyright
© 2021 Published by Elsevier Inc.
