Active surveillance selection and 3-year durability in intermediate-risk prostate cancer following genomic testing.

IF 5.1 2区 医学 Q1 ONCOLOGY Prostate Cancer and Prostatic Diseases Pub Date : 2024-09-05 DOI:10.1038/s41391-024-00888-y
Lauren Lenz, Wyatt Clegg, Diana Iliev, Chelsea R Kasten, Howard Korman, Todd M Morgan, Jason Hafron, Alexander DeHaan, Carl Olsson, Ronald F Tutrone, Timothy Richardson, Kevin Cline, Paul M Yonover, Jeff Jasper, Todd Cohen, Robert Finch, Thomas P Slavin, Alexander Gutin
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Abstract

Background: Genomic testing can add risk stratification information to clinicopathological features in prostate cancer, aiding in shared medical decision-making between the clinician and patient regarding whether active surveillance (AS) or definitive treatment (DT) is most appropriate. Here we examined initial AS selection and 3-year AS durability in patients diagnosed with localized intermediate-risk prostate cancer who underwent Prolaris testing before treatment decision-making.

Methods: This retrospective observational cohort study included 3208 patients from 10 study sites who underwent Prolaris testing at diagnosis from September 2015 to December 2018. Prolaris utilizes a combined clinical cell cycle risk score calculated at diagnostic biopsy to stratify patients by the Prolaris AS threshold (below threshold, patient recommended to AS or above threshold, patient recommended to DT). AS selection rates and 3-year AS durability were compared in patients recommended to AS or DT by Prolaris testing. Univariable and multivariable logistic regression models and Cox proportional hazard models were used with molecular and clinical variables as predictors of initial treatment decision and AS durability, respectively.

Results: AS selection was ~2 times higher in patients recommended to AS by Prolaris testing than in those recommended to DT (p < 0.0001). Three-year AS durability was ~1.5 times higher in patients recommended to AS by Prolaris testing than in those recommended to DT (p < 0.0001). Prolaris treatment recommendation remained a statistically significant predictor of initial AS selection and AS durability after accounting for CAPRA or Gleason scores.

Conclusions: Prolaris added significant information to clinical risk stratification to aid in treatment decision making. Intermediate-risk prostate cancer patients who were recommended to AS by Prolaris were more likely to initially pursue AS and were more likely to remain on AS at 3 years post-diagnosis than patients recommended to DT.

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基因组检测后中危前列腺癌的主动监测选择和 3 年耐受性。
背景:基因组检测可在前列腺癌临床病理特征的基础上增加风险分层信息,有助于临床医生和患者就最合适的是积极监测(AS)还是明确治疗(DT)共同做出医疗决策。在此,我们研究了在治疗决策前接受 Prolaris 检测的局部中危前列腺癌患者的初始 AS 选择和 3 年 AS 耐用性:这项回顾性观察队列研究纳入了来自 10 个研究地点的 3208 名患者,他们在 2015 年 9 月至 2018 年 12 月期间接受了 Prolaris 检测。Prolaris 利用诊断性活检时计算的临床细胞周期风险综合评分,按照 Prolaris AS 阈值对患者进行分层(低于阈值,建议患者接受 AS 或高于阈值,建议患者接受 DT)。比较了通过Prolaris检测被推荐为AS或DT患者的AS选择率和3年AS耐久性。采用单变量和多变量逻辑回归模型以及Cox比例危险模型,分别将分子变量和临床变量作为初始治疗决定和AS耐久性的预测因子:结果:通过 Prolaris 检测被推荐接受 AS 治疗的患者的 AS 选择率是被推荐接受 DT 治疗的患者的 2 倍(p 结论:Plaris 为临床治疗增加了重要信息:Prolaris 为临床风险分层增加了重要信息,有助于做出治疗决定。与被推荐接受 DT 的患者相比,被 Prolaris 推荐接受 AS 的中危前列腺癌患者更有可能开始接受 AS,并且更有可能在诊断后 3 年继续接受 AS。
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来源期刊
Prostate Cancer and Prostatic Diseases
Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学
CiteScore
10.00
自引率
6.20%
发文量
142
审稿时长
6-12 weeks
期刊介绍: Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.
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