NCCN Risk Reclassification in Black Men with Low and Intermediate Risk Prostate Cancer After Genomic Testing - 28/05/22

Doi : 10.1016/j.urology.2021.08.055

Benjamin Seiden ^1,^2,^3,^{^{#
These two authors contributed equally}}, Stanley Weng ^1,^2,^3,^{^{#
These two authors contributed equally}}, Natalie Sun ¹, Danielle Gordon ^2,³, William N. Harris ^2,³, Jack Barnett ¹, Akya Myrie ¹, Tashzna Jones ⁴, So Yeon Pak ¹, Ahd Fudl ¹, John Shields ^2,³, Brian K McNeil ^2,³, Jeffrey P Weiss ^2,³, Matthew T. Smith ^2,³, Ashanda R Esdaille ⁵, Andrew G. Winer ^2,^3,^⁎
¹ SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, NY
² Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY
³ Department of Urology, Kings County Hospital Center, Brooklyn, NY
⁴ Department of Urology, Yale New Haven Hospital, New Haven, CT
⁵ Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI

^⁎Address correspondence to: Andrew G. Winer, MD, Kings County Hospital Center, 451 Clarkson Ave, Brooklyn, NY 11203.Kings County Hospital Center451 Clarkson AveBrooklynNY11203

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

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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.

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Abbreviations : PCa, AS, NCCN, GPS, PSA, PSAD, PIRADS, VLR, LR, UIR, FIR, HR, DRE, RP, RT, mpMRI