The genetic signature predicted which patients were more likely to develop distant metastases (HR 1.24, 95% CI 1.11-1.39), which were more likely to die of their prostate cancer (HR 1.27, 95% CI 1.13-1.43) and which were more likely to die from any cause (HR 1.12, 95% CI 1.05-1.20). For example, the rate of distant cancer metastasis at 10 years was 29% for patients whose scores indicated they had more aggressive cancer, compared to 13% for those whose scores signaled lower risk.
While the Decipher test was previously validated using tissue samples taken after radical prostatectomy, the current meta-analysis examined tissue taken before treatment, at the time of initial diagnosis. "This study is the first to validate a genetic biomarker for high-risk prostate cancer using pre-treatment archival tissue from large prospective randomized trials," said Dr. Nguyen. "Using archival tissue samples from a wide range of centers and patients—hundreds of cancer centers across the country—shows that this test can be helpful for many men with high-risk disease."
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The age of the samples also meant that researchers could examine very long-term outcomes on the patients with high-risk prostate tumors. "A strength of using this tissue is that we have the complete follow-up for 20 to 30 years on these patients," said Dr. Nguyen.
Dr. Nguyen emphasized that the test needs further validation before it can become widely adopted. To that end, the NRG-GU009/PREDICT-RT trial led by Dr. Nguyen and Dr. Oliver Sartor is currently enrolling patients with high-risk prostate cancer to test Decipher's predictive validity in a prospective randomized trial.
"For a man with high-risk prostate cancer, this genetic score can be a very powerful prognostic tool that can tell us whether he is likely to be cured from treatment or is likely to see his cancer return again," said Dr. Nguyen. "I see this as a great opportunity to change the standard of care for patients in the future by using genomics to personalize therapy."
ABOUT ASTRO
The American Society for Radiation Oncology (ASTRO) is the largest radiation oncology society in the world, with nearly 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. For information on radiation therapy, visit RTAnswers.org. To learn more about ASTRO, visit our website and follow us on social media.
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