Annals of Internal MedicineImpact of Genomic Classifiers on Risk Stratification and Treatment Intensity in Patients with Localized Prostate Cancer: A Systematic Review

This systematic review examines the clinical utility of three genomic classifiers (Decipher, Oncotype DX GPS, and Prolaris) in risk stratification and treatment decisions for localized prostate cancer. The analysis spans literature from 2010 to 2024, focusing on first-line treatment considerations.

Study Design:

• Literature review of MEDLINE, EMBASE, and Web of Science databases
• Dual investigator screening and risk of bias assessment
• 10 studies on risk reclassification
• 12 observational studies on treatment decisions
• 1 randomized trial included

Key Findings:

• Risk reclassification patterns varied by test:
  • GPS: 88.1-100% same/lower risk
  • Decipher: 82.9-87.2% same/lower risk
  • Prolaris: 76.9% same/lower risk
• Randomized trial showed higher risk reclassification:
  • 34.5% of very low-risk patients reclassified higher
  • 29.4% of low-risk patients reclassified higher
• Treatment decisions:
  • Observational studies showed minimal change or slight preference for active surveillance
  • Randomized trial indicated decreased active surveillance selection after GPS testing

HCN Medical Memo
The discrepancy between observational and randomized trial findings suggests that genomic classifier testing may have more impact on clinical decision-making than previously indicated by real-world data. Clinicians should consider this variation when incorporating genomic testing into their practice protocols for localized prostate cancer management.

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