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Genomic Classifiers and Gleason Grade Group in Active Surveillance: Refining Risk Stratification in Prostate Cancer
Nethusan Sivanesan, BS, Gabriela M. Diaz, MD, Sebastian Strachan, MD, Darryl T. Martin, PhD, Peter S. Palencia, BS, Shayan Smani, BS, Wei S. Tan, MD,PhD, Isaac Y. Kim, MD, PhD, Micahel S. Leapman, MD, MHS, Preston C. Sprenkle, MD.
Yale School of Medicine, New Haven, CT, USA.
BACKGROUND: The role of genomic classifiers (GC) in refining risk stratification among patients with biopsy Gleason grade group (GG) 1 and GG2 on active surveillance (AS) remains unclear. This study evaluates the impact of Decipher GC testing on progression to treatment over five years in AS patients.
METHODS:We conducted a retrospective study of patients with biopsy GG1 or GG2 who underwent Decipher GC testing and had at least two biopsies. Patients were stratified by GG and GC risk groups (low: 0-0.45; intermediate/high: >0.45). Descriptive statistics, Kaplan-Meier analysis, and Cox proportional hazards regression were used to assess progression to treatment, defined as GG2 intermediate/high Decipher or GG3+ on subsequent biopsy.
RESULTS: We identified 287 patients: 189 (47.1%) GG1/GC low, 38 (50%) GG1/GC intermediate/high, and 60 (26.7%) GG2/GC low. Overall, 176 (58.6%) met treatment criteria. Progression rates differed significantly among GG and GC groups (Figure 1). GG1/GC low patients progressed more slowly, reaching the treatment threshold at 36 months, while GG1/GC intermediate/high and GG2/GC low groups did so at 14 months. Cox regression showed GG1/GC intermediate/high (HR 2.15, p=0.004) and GG2/GC low (HR 2.56, p<0.001) were associated with higher odds of reaching treatment criteria relative to GG1/GC low when adjusting for PIRADS 4-5 (HR 1.42, p=0.253) and PSAD (HR 0.716, p=1.42).
CONCLUSIONS:Patients with GG1/GC low followed expected surveillance patterns, while patients with GG1/GC intermediate/high behave similarly to GG2/GC low in progression risk. These findings highlight the importance of GC in refining risk stratification for patients on AS.
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