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AUA 2017

AUA 2017: Decipher test impacts decision-making among patients considering adjuvant and salvage treatment following radical prostatectomy – Interim results from the multicenter prospective PRO-IMPACT Study

Boston, MA (UroToday.com) In this session. Dr. Gore presented his work on how the decipher test impact patient and provider decision-making regarding adjuvant versus salvage radiation therapy after radical prostatectomy. Decipher is a genomic test that predicts disease progression after radical prostatectomy. The objective of the study was to evaluate the impact of Decipher test on patients’ and clinicians’ decision-making for adjuvant and salvage treatment after radical prostatectomy in a prospective cohort.

The methodology involved a pre-Decipher office visit and a post-Decipher office visit. At each time point, treatment recommendations, patient and provider decisional conflict scales, and quality of life measurements were obtained. Of 284 patients in the pre-decipher office visit group, there were 9 withdrawals due to lack of tissue, 8 for protocol deviations, 2 lost to follow-up, and 1 who withdrew consent.

One hundred fifty patients were in the adjuvant arm and 115 patients were in the salvage arm. The percentage of Decipher high risk was 32% in the adjuvant arm and 41.7% in the salvage arm. In the adjuvant arm, the pre-Decipher “default” recommendation was observation in 90% of patients. Post-Decipher recommendations changed 18% overall, and there was a clear trend favoring treatment in patients with higher risk Decipher scores. In the salvage population, the observation recommendation was not as strong at baseline; however, the Decipher test resulted in a 32% overall change in treatment recommendations. Moreover, in the multivariable model, Decipher was associated with treatment in both the adjuvant (OR 1.48, 95% CI 1.19-1.85) and salvage (OR 1.30, 95% CI 1.03-1.65) arms. An overall reduction in decisional conflict was noted for both patients and providers. Notably, these reductions were most common in the patient uncertainty and patient support domains.

The authors concluded that use of the Decipher test resulted in a change in treatment decision in a substantial portion of men with prostate cancer considering adjuvant or salvage therapy. Decision quality improved for both patients and providers with use of the Decipher test.

Presented By: John Gore, MD, MS

Written By: Benjamin T. Ristau, MD, Fox Chase Cancer Center, Philadelphia, PA

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA