Can Genomic Testing Impact Treatment Choice for Low-Risk Prostate Cancer?
Posted: Tuesday, June 29, 2021
Genomic testing of biopsied tissue may impact the decision to accept active surveillance treatment in Black patients with low-risk prostate cancer, according to a multicenter randomized trial. In particular, patients informed of their Genomic Prostate Score (GPS) who had lower health literacy as well as patients without a family history of prostate cancer or health insurance appeared to be less likely to select active surveillance. The results of this prospective study were published in the Journal of Clinical Oncology.
“In contrast to other studies, the net effect of the GPS was to move patients away from active surveillance, primarily among men with low health literacy. These findings have implications for our understanding of how prognostic molecular assays that generate probabilities of poor outcome can affect treatment decisions in diverse clinical populations,” stated Peter H. Gann, MD, ScD, of the University of Illinois at Chicago, and colleagues.
Men (70% Black, 16% college graduates) with very low– to low-intermediate prostate cancer scores were enrolled (n = 317). Patients were randomly assigned to receive standard counseling with or without a 12-gene GPS assay. The proportion of patients to accept active surveillance at the second postdiagnosis visit was compared between groups, and multivariable modeling was utilized to assess additional factors on treatment acceptance.
Overall, the acceptance of active surveillance was high, and it appeared to be slightly less in the non-GPS assay group (77%) compared with the GPS-assay group (88%; P = .067). When patients who did not provide adequate biopsy specimens were excluded from this analysis, the difference was more pronounced (P = .029). Patients with lower health literacy who had a GPS were seven times less likely to accept active surveillance than those who did not receive a GPS score, whereas patients with higher health literacy did not differ in choice between groups. Patients who had health insurance or a family history of prostate cancer were found to be three to four times more likely to accept active surveillance, respectively.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.