What is the role of biologic assays in prostate cancer risk stratification?

Updated: Jan 15, 2019
  • Author: Lanna Cheuck, DO; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

This problem has sparked the advent of research and use of biological/genomic assays to help risk stratify men diagnosed with localized prostate cancer. The theory behind utilizing genomic assays is to identify genes in biopsy specimens that potentiate cellular proliferation.

Cooperberg et al aimed to validate the application of the cell cycle progression score (CCP score) in identifying men at risk for recurrent disease after radical prostatectomy. [35] The CCP score identifies genes that promote cellular proliferation. In this study, the CCP score was compared with the Cancer of the Prostate Risk Assessment post-Surgical (CAPRA-S score), which risk stratifies recurrence after prostatectomy based on pre-procedural PSA, Gleason score, and clinical staging, and has been shown to have good accuracy. [35]

The CCP score predicted recurrence with a hazard ratio (HR) of 2.1 per unit increase in score. [35] In addition, the CCP score found an HR of 2.3 in some men with CAPRA-S scores of 0-2 (low risk of recurrence). Improved accuracy in predicting 10-year progression was noted when CCP score was combined with CAPRA-S score. [35]

In a similar study, Cuzick et al applied the CCP score to men with localized prostate cancer diagnosed by transurethral resection of the prostate (TURP). [36] The primary endpoint of the study was time to death. CCP score was found to be the most important variable and strongest prognostic factor for predicting time to death from prostate cancer. [36]

Klein et al assessed the use of Decipher, a 22-biomarker assay, on tissue retrieved from radical prostatectomy (RP) specimens from 1987 to 2008 for predicting the rate of recurrence. Within a cohort of 57 patients with preoperative diagnostic needle biopsy specimens, the primary objective was to validate biopsy-based Decipher for prediction of metastasis within 10 years of RP. [37] Biopsy-based Decipher was shown to be a significant predictor of recurrence within 10 years of RP, based on univariate and multivariate analysis, and was also a significant predictor of primary Gleason grade 4 or greater and rapid metastatic disease, two secondary endpoints of the study. [37]


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