EURURO Vol. 72 No. 5

845 860

Prostate Cancer
Ability of a Genomic Classifier to Predict Metastasis and Prostate
Cancer-specific Mortality after Radiation or Surgery based on
Needle Biopsy Specimens
Paul L. Nguyen Zaid Haddad Ashley E. Ross Neil E. Martin Samineh Deheshi
Lucia L.C. Lam Jijumon Chelliserry Jeffrey J. Tosoian Tamara L. Lotan Daniel E. Spratt
Radka S. Stoyanova Sanoj Punnen Kaye Ong Christine Buerki Maria Aranes
Tyler Kolisnik Jennifer Margrave Kasra Yousefi Voleak Choeurng Elai Davicioni
Bruce J. Trock Christopher J. Kane Alan Pollack John W. Davis Felix Y. Feng y, Eric A. Klein
a Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center and Harvard Medical School, Boston, MA, USA; b GenomeDx
Biosciences Inc., Vancouver, BC, Canada; c James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA; d Department of
Radiation Oncology, Michigan Center for Translational Pathology, Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA; e Department of
Radiation Oncology, Miller School of Medicine University of Miami, Miami, FL, USA; f Department of Urology, University of California, San Diego, San Diego,
CA, USA; g Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; hDepartment of Radiation Oncology, University
of California at San Francisco, San Francisco, CA, USA; i Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
ava ilable at
journal homepage:
Article info
Article history:
Accepted May 3, 2017
Associate Editor:
James Catto
Keywords:
Biopsy
Prostate cancer-specific
mortality
Metastasis
Genomics
Abstract
Background: Decipher is a validated genomic classifier developed to determine the
biological potential for metastasis after radical prostatectomy (RP).
Objective: To evaluate the ability of biopsy Decipher to predict metastasis and Prostate
cancer-specific mortality (PCSM) in primarily intermediate- to high-risk patients treated
with RP or radiation therapy (RT).
Design, setting, and participants: Two hundred and thirty-five patients treated with
either RP (n = 105) or RT androgen deprivation therapy (n = 130) with available genomic
expression profiles generated from diagnostic biopsy specimens from seven tertiary referral
centers. The highest-grade core was sampled and Decipher was calculated based on a locked
random forest model.
Outcome measurements and statistical analysis: Metastasis and PCSMwere the primary
and secondary outcomes of the study, respectively. Cox analysis and c-index were used
to evaluate the performance of Decipher.
Results and limitations: With a median follow-up of 6 yr among censored patients,
34 patients developed metastases and 11 died of prostate cancer. On multivariable
analysis, biopsy Decipher remained a significant predictor of metastasis (hazard ratio:
1.37 per 10% increase in score, 95% confidence interval [CI]: 1.06–1.78, p = 0.018) after
adjusting for clinical variables. For predicting metastasis 5-yr post-biopsy, Cancer of the
Prostate Risk Assessment score had a c-index of 0.60 (95% CI: 0.50–0.69), while Cancer of
the Prostate Risk Assessment plus biopsy Decipher had a c-index of 0.71 (95% CI: 0.60–
0.82). National Comprehensive Cancer Network risk group had a c-index of 0.66 (95% CI:
0.53–0.77), while National Comprehensive Cancer Network plus biopsy Decipher had a
c-index of 0.74 (95% CI: 0.66–0.82). Biopsy Decipher was a significant predictor of PCSM
y These authors have contributed equally to this work.
* Corresponding author. 75 Francis Street, Boston, MA 02115, USA. Tel. +16177327936.
E-mail address: (P.L. Nguyen).
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. This is an open access article under the CC
BY-NC-ND license ).