Association Between a 22-feature Genomic Classifier and Biopsy Gleason Upgrade During Active Surveillance for Prostate Cancer

BackgroundAlthough the Decipher genomic classifier has been validated as a prognostic tool for several prostate cancer endpoints, little is known about its role in assessing risks of biopsy reclassification among patients on active surveillance, a key event that often triggers treatment. ObjectiveTo evaluate the association between Decipher genomic classifier and biopsy Gleason upgrade among patients on active surveillance. Design, Setting, and ParticipantsRetrospective cohort study among patients with low- and favorable-intermediate-risk prostate cancer on active surveillance who underwent biopsy-based Decipher testing as part of clinical care. Outcomes measures and statistical analysisAny increase in biopsy Gleason grade group (GG). We evaluated the association between Decipher score using univariable and multivariable logistic regression. We compared area under the receiver operating characteristic curve (AUC) of models comprised of baseline clinical variables with or without Decipher score. Results and limitationsWe identified 133 patients of median age 67.7 years and median PSA 5.6 ng/mL. At enrollment 75.9% were GG1 and 24.1 GG2. Forty-three patients experienced biopsy upgrade. On multivariable logistic regression, Decipher score was significantly associated with biopsy upgrade (OR 1.37 per 0.10 unit increase, 95% CI 1.05-1.79 p=0.02). Decipher score was associated with upgrade among patients with biopsy Grade group 1, but not Grade Group 2 disease. The discriminative ability of a clinical model (AUC 0.63, 95% CI 0.51-0.74) was improved with the integration of Decipher score (AUC 0.69, 95% CI 0.58-0.80). ConclusionsThe Decipher genomic classifier was associated with short-term biopsy Gleason upgrading among patients on active surveillance. Patient summaryThe results from this study indicate that among patients with prostate cancer undergoing active surveillance, those with higher Decipher scores were more likely to have higher-grade disease found over time. These findings indicate that the Decipher test might be useful for guiding the intensity of monitoring during active surveillance.