Contemporary Role of the Decipher® Test in Prostate Cancer Management: Current Practice and Future Perspectives.

We performed a systematic literature search to identify original articles and editorials about the Decipher(®) Prostate Cancer Test (GenomeDx Biosciences, San Diego, CA) to provide an overview of the current literature and its present role in urologic clinical practice. The Decipher test, which uses the expression of 22 selected RNA markers (from a total of over 1.4 million), showed a very high discrimination in predicting clinical metastasis (0.75-0.83) and cancer-specific mortality (0.78) in external validation studies, outperforming all routinely available clinicopathologic characteristics. Further, the timing of postoperative radiotherapy (adjuvant vs salvage) may be guided based on Decipher scores. The Decipher test was also the only independent predictor of clinical metastasis in patients with biochemical recurrence after surgery. The Decipher Genomic Resource Information Database (GRID) is a novel research tool that captures 1.4 million marker expressions per patient and may facilitate precision-guided, individualized care to patients with prostate cancer. In this era of precision medicine, Decipher, along with the Decipher GRID platform, is a promising genomic tool that may aid in managing prostate cancer patients throughout the continuum of care and delivering appropriate treatment at an individualized level.

[1]  M. Cooperberg,et al.  The CAPRA‐S score , 2011, Cancer.

[2]  R. Thompson,et al.  Is the GPSM scoring algorithm for patients with prostate cancer valid in the contemporary era? , 2007, The Journal of urology.

[3]  Eugenia G. Giannopoulou,et al.  The oestrogen receptor alpha-regulated lncRNA NEAT1 is a critical modulator of prostate cancer , 2014, Nature Communications.

[4]  R. Karnes,et al.  Deciphering the genomic fingerprint of small cell prostate cancer with potential clinical utility. , 2016 .

[5]  A. Chinnaiyan,et al.  The IncRNAs PCGEM1 and PRNCR1 are not implicated in castration resistant prostate cancer. , 2014 .

[6]  H. Heinzer,et al.  Identifying the Most Informative Prediction Tool for Cancer-specific Mortality After Radical Prostatectomy: Comparative Analysis of Three Commonly Used Preoperative Prediction Models. , 2016, European urology.

[7]  Jianbo Li,et al.  Decipher Genomic Classifier Measured on Prostate Biopsy Predicts Metastasis Risk. , 2016, Urology.

[8]  F. Feng,et al.  Genomic classifier identifies men with adverse pathology after radical prostatectomy who benefit from adjuvant radiation therapy. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[9]  M. Cooperberg,et al.  Application of a Clinical Whole-Transcriptome Assay for Staging and Prognosis of Prostate Cancer Diagnosed in Needle Core Biopsy Specimens. , 2016, The Journal of molecular diagnostics : JMD.

[10]  Christopher J Kane,et al.  Prostate Cancer, Version 1.2016. , 2016, Journal of the National Comprehensive Cancer Network : JNCCN.

[11]  N. Willich,et al.  Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  A W Partin,et al.  Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. , 1997, JAMA.

[13]  S. Faraj,et al.  Androgen-Regulated SPARCL1 in the Tumor Microenvironment Inhibits Metastatic Progression. , 2015, Cancer research.

[14]  John T. Wei,et al.  RNA biomarkers associated with metastatic progression in prostate cancer: a multi-institutional high-throughput analysis of SChLAP1. , 2014, The Lancet. Oncology.

[15]  A. Stephenson,et al.  Radiation therapy for prostate cancer after prostatectomy: adjuvant or salvage? , 2011, Nature Reviews Urology.

[16]  R. Uzzo,et al.  Low rates of adjuvant radiation in patients with nonmetastatic prostate cancer with high‐risk pathologic features , 2014, Cancer.

[17]  B. Trock,et al.  Characterization of 1577 primary prostate cancers reveals novel biological and clinicopathologic insights into molecular subtypes. , 2015, European urology.

[18]  Impact of a genomic classifier of metastatic risk on postoperative treatment recommendations for prostate cancer patients: a report from the DECIDE study group , 2013, Oncotarget.

[19]  B. Trock,et al.  The natural history of metastatic progression in men with prostate‐specific antigen recurrence after radical prostatectomy: long‐term follow‐up , 2012, BJU international.

[20]  Jennifer R. Rider,et al.  Germline Variants in Asporin Vary by Race, Modulate the Tumor Microenvironment, and Are Differentially Associated with Metastatic Prostate Cancer , 2015, Clinical Cancer Research.

[21]  B. Trock,et al.  Recurrence After Radical Prostatectomy Radiotherapy vs Observation in Men With Biochemical Prostate CancerSpecific Survival Following Salvage , 2008 .

[22]  Anirban P. Mitra,et al.  A genomic classifier predicting metastatic disease progression in men with biochemical recurrence after prostatectomy , 2013, Prostate Cancer and Prostatic Disease.

[23]  C. Kane,et al.  Evaluation of a genomic classifier in radical prostatectomy patients with lymph node metastasis , 2016, Research and reports in urology.

[24]  U. Capitanio,et al.  Impact of adjuvant radiation therapy on urinary continence recovery after radical prostatectomy. , 2014, European urology.

[25]  E. Klein,et al.  Racial Variations in Prostate Cancer Molecular Subtypes and Androgen Receptor Signaling Reflect Anatomic Tumor Location. , 2016, European urology.

[26]  L. Collette,et al.  Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911) , 2012, The Lancet.

[27]  A. Jemal,et al.  Cancer statistics, 2015 , 2015, CA: a cancer journal for clinicians.

[28]  S. Dhanasekaran,et al.  The long noncoding RNA SChLAP1 promotes aggressive prostate cancer and antagonizes the SWI/SNF complex , 2013, Nature Genetics.

[29]  F. Feng,et al.  Genomic Prostate Cancer Classifier Predicts Biochemical Failure and Metastases in Patients After Postoperative Radiation Therapy , 2014, International journal of radiation oncology, biology, physics.

[30]  Anirban P. Mitra,et al.  Validation of a genomic classifier that predicts metastasis following radical prostatectomy in an at risk patient population. , 2013, The Journal of urology.

[31]  P. Saylor,et al.  Metabolic complications of androgen deprivation therapy for prostate cancer. , 2009, The Journal of urology.

[32]  C. Lawton.  Adjuvant Radiotherapy for Pathological T3N0M0 Prostate Cancer Significantly Reduces Risk of Metastases and Improves Survival: Long-Term Followup of a Randomized Clinical Trial , 2010 .

[33]  M. Kattan,et al.  A genomic classifier improves prediction of metastatic disease within 5 years after surgery in node-negative high-risk prostate cancer patients managed by radical prostatectomy without adjuvant therapy. , 2015, European urology.

[34]  J. Hornberger,et al.  Influence of a genomic classifier on post-operative treatment decisions in high-risk prostate cancer patients: results from the PRO-ACT study , 2014, Current medical research and opinion.

[35]  E. Klein,et al.  The Landscape of Prognostic Outlier Genes in High-Risk Prostate Cancer , 2015, Clinical Cancer Research.

[36]  B. Trock,et al.  Tissue-based Genomics Augments Post-prostatectomy Risk Stratification in a Natural History Cohort of Intermediate- and High-Risk Men. , 2016, European urology.

[37]  S. Groshen,et al.  AXIN2 expression predicts prostate cancer recurrence and regulates invasion and tumor growth , 2015, The Prostate.

[38]  Misop Han,et al.  Predicting 15-year prostate cancer specific mortality after radical prostatectomy. , 2011, The Journal of urology.

[39]  J. Kirkpatrick.  Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. , 1998, Journal of insurance medicine.

[40]  Michael W Kattan,et al.  Postoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[41]  Darby J. S. Thompson,et al.  Recalibration of genomic risk prediction models in prostate cancer to improve individual-level predictions. , 2015 .

[42]  U. Capitanio,et al.  Selecting the optimal candidate for adjuvant radiotherapy after radical prostatectomy for prostate cancer: a long-term survival analysis. , 2013, European urology.

[43]  K. Badani,et al.  Impact of a Genomic Classifier of Metastatic Risk on Postprostatectomy Treatment Recommendations by Radiation Oncologists and Urologists. , 2015, Urology.

[44]  Richard K Valicenti,et al.  Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[45]  R. Abouassaly,et al.  Low Use of Immediate and Delayed Postoperative Radiation for Prostate Cancer with Adverse Pathological Features. , 2015, The Journal of urology.

[46]  K. Yousefi,et al.  Validation of a Genomic Classifier for Predicting Post-Prostatectomy Recurrence in a Community Based Health Care Setting. , 2016, The Journal of urology.

[47]  K. Badani,et al.  Effect of a genomic classifier test on clinical practice decisions for patients with high-risk prostate cancer after surgery , 2014, BJU international.

[48]  S. Freedland,et al.  Utilization of a Genomic Classifier for Prediction of Metastasis Following Salvage Radiation Therapy after Radical Prostatectomy. , 2016, European urology.

[49]  T. Rebbeck,et al.  Novel Biomarker Signature That May Predict Aggressive Disease in African American Men With Prostate Cancer. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[50]  Anamaria Crisan,et al.  Combined value of validated clinical and genomic risk stratification tools for predicting prostate cancer mortality in a high-risk prostatectomy cohort. , 2015, European urology.