Changes in Serial Decipher Genomic Classifier Testing Among Patients with Prostate Cancer Managed with Active Surveillance
Ghazal Khajir, MD, Darryl T. Martin, PhD, Daniel Halstuch, MD, Michael S. Leapman, MD, Michael S. Leapman, MD, Isaac Y. Kim, MD, PhD, Preston C. Sprenkle, MD.
Yale school of medicine, New Haven, CT, USA.
BACKGROUND: The role of serial tissue-based gene expression (genomic) testing among patients managed with active surveillance (AS) for localized prostate cancer is unclear. We aimed to examine patterns of serial genomic testing with the Decipher genomic classifier (GC) and assess the relationships between changes in GC and short term clinical outcomes. METHODS: We performed a retrospective analysis of patients on AS for prostate cancer who underwent GC testing on at least two distinct prostate biopsies occurring between January 2017 and May 2022. The primary study objective was to assess the association between changes in GC and Gleason grade group (GG) upgrade during surveillance. Among the subset of patients who were treated with radical prostatectomy (RP), we evaluated the relationship between GC changes and the detection of adverse pathology (GG ≥3 and or pT3a or N1). RESULTS: We identified 149 patients enrolled in AS for GG1 (n=105, 70.5%), GG2 (n=41, 27.5%), or GG3 (n=3, 2%) prostate cancer who received serial GC testing. GC scores decreased from the first to the second biopsy in 61 (40.9%) patients on AS and increased in 87 (58.4%) (Figure 1). The median change in GC scores was 0.03, (interquartile range, IQR -0.11 to +0.16). Increases in GC were observed in 27 (25.7%) patients with biopsy GG1 on initial biopsy, 11 (26.8%) with GG2, and no patients with initial GG3 disease (p=0.58). Among 71 patients who underwent a subsequent prostate biopsy, Gleason upgrade occurred in 31 (43.7%). In multivariable logistic regression, GC increase (odds ratio, OR per 0.10 increase 0.93, 95% CI 0.71-1.22, p=0.61) was not significantly associated with Gleason upgrade. Adverse pathology was identified in 7 of 25 (28%) patients treated with RP of whom the median change in Decipher score was +0.01, compared with +0.01 of those with favorable pathology (p=0.90). CONCLUSIONS: Among patients undergoing Decipher GC testing during AS for prostate cancer, there was substantial variation in serial test results; however, increases in GC were not associated with short-term biopsy upgrade. 
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