While genomic classifier (GC) tests may influence risk and treatment decisions for patients with localised prostate cancer (PCa), there is a need for better data on their cost-effectiveness, clinical utility, and their impact on racial and ethnic groups, say researchers
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 tumour stage, PSA levels, and Gleason grades.
However, these tools are not perfect and can sometimes lead to overtreatment or undertreatment. Tests like Decipher by Veracyte, Prolaris by Myriad Genetics, and Oncotype DX Genomic Prostate Score (GPS) by MDx offer a genetic snapshot of tumour 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.
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 localised prostate cancer.
The researchers analysed 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.
This pattern differed across GC test types, however, with GPS-based studies finding 0 per cent – 11.9 per cent of patients were reclassified to a higher risk category versus Decipher-based studies finding 12.8 per cent to 17.1 per cent reclassified to a higher risk category.
In a randomised 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.
The researchers note that the differences in results from observational and randomized trials emphasise the need for well-designed trials evaluating the impact of GC tests in management of PCa to inform patient-clinician decision-making.
