A High Decipher Genomic Risk Score Is Associated with Major Pathological Progression in Patients Undergoing Active Surveillance for Prostate Cancer.

Genomic testing has potential to improve clinical decision-making for men with prostate cancer, but is understudied for active surveillance (AS), the standard management option for favorable-risk disease. We investigated whether Decipher scores are associated with AS outcomes in a cohort of patients on AS with at least two biopsies and a Decipher test. Decipher high-risk was defined as a score ≥0.6. Primary outcomes were any upgrading (any increase in grade group [GG]), major upgrading (GG ≥3), and unfavorable histology on subsequent biopsy. Multivariable Cox proportional-hazards regression models were generated for the cohort of 486 patients. On diagnostic biopsy, 78% had low risk and 22% had intermediate risk according to Cancer of the Prostate Risk Assessment (CAPRA) scores, and 12% had high risk according to Decipher. Decipher scores were associated with major upgrading after adjusting for CAPRA scores (hazard ratio [HR] 3.37, 95% confidence interval [CI] 1.17-9.69); high Decipher risk was associated with major upgrading after adjustment for either the CAPRA score (HR 2.00, 95% CI 1.14-3.49) or clinicodemographic variables (HR 2.65, 95% CI 1.36-5.17). The Decipher score was associated with unfavorable histology after adjustment for the CAPRA score (HR 3.68, 95% CI 1.03-13.08); high Decipher risk was associated with unfavorable histology after adjustment for clinicodemographic variables (HR 4.53, 95% CI 2.03-10.15) but not after adjustment for the CAPRA score. No association was observed for any upgrading. Deintensification of surveillance may be warranted for patients with lower Decipher risk.