Association Between the Decipher Genomic Classifier and Prostate Cancer Outcome in the Real-world Setting

Background and objectiveAlthough the prognostic significance of the Decipher prostate cancer genomic classifier (GC) has been established largely from analyses of archival tissue, less is known about the associations between the results of Decipher testing and oncologic outcomes among patients receiving contemporaneous testing and treatment in the real-world practice setting. Our objective was to assess the associations between the Decipher GC and risks of metastasis and biochemical recurrence (BCR) following prostate biopsy and radical prostatectomy (RP) among patients tested and treated in the real-world setting. MethodsA retrospective cohort study was conducted using a novel longitudinal linkage of transcriptomic data from the Decipher GC and real-world clinical data (RWD) aggregated from insurance claims, pharmacy records, and electronic health record data across payors and sites of care. Kaplan-Meier and Cox proportional hazards regressions were used to examine the associations between the GC and study outcomes, adjusting for clinical and pathologic factors. Key findings and limitationsMetastasis from prostate cancer and BCR after radical prostatectomy, Decipher GC continuous score, and risk categories were evaluated. We identified 58 935 participants who underwent Decipher testing, including 33 379 on a biopsy specimen and 25 556 on an RP specimen. The median age was 67 yr (interquartile range IQR 62–72) at biopsy testing and 65 yr (IQR 59–69) at RP. The median GC score was 0. 43 (IQR 0. 27–0. 66) among biopsy-tested patients and 0. 54 (0. 32–0. 79) among RP-tested patients. The GC was independently associated with the risk of metastasis among biopsy-tested (hazard ratio HR per 0. 1 unit increase in GC 1. 21 95% confidence interval CI 1. 16–1. 27, p < 0. 001) and RP-tested (HR 1. 20 95% CI 1. 17–1. 24, p < 0. 001) patients after adjusting for baseline clinical and pathologic risk factors. In addition, the GC was associated with the risk of BCR among RP-tested patients (HR 1. 12 95% CI 1. 10–1. 14, p < 0. 001) in models adjusted for age and Cancer of the Prostate Risk Assessment postsurgical score. Conclusions and clinical implicationsThis real-world study of a novel transcriptomic linkage conducted at a national scale supports the external prognostic validity of the Decipher GC among patients managed in contemporary practice. Patient summaryThis study looked at the use of the Decipher genomic classifier, a test used to help understand the aggressiveness of a patient's prostate cancer. Looking at the results of 58 935 participants who underwent testing, we found that the Decipher test helped estimate the risk of cancer recurrence and metastasis.