TY - JOUR
T1 - Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy
T2 - Interim results from the Multicenter Prospective PRO-IMPACT study
AU - Gore, John L.
AU - Plessis, Marguerite du
AU - Santiago-Jiménez, María
AU - Yousefi, Kasra
AU - Thompson, Darby J.S.
AU - Karsh, Lawrence
AU - Lane, Brian R.
AU - Franks, Michael
AU - Chen, David Y.T.
AU - Bandyk, Mark
AU - Bianco, Fernando J.
AU - Brown, Gordon
AU - Clark, William
AU - Kibel, Adam S.
AU - Kim, Hyung L.
AU - Lowrance, William
AU - Manoharan, Murugesan
AU - Maroni, Paul
AU - Perrapato, Scott
AU - Sieber, Paul
AU - Trabulsi, Edouard J.
AU - Waterhouse, Robert
AU - Davicioni, Elai
AU - Lotan, Yair
AU - Lin, Daniel W.
N1 - Publisher Copyright:
© 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society
PY - 2017/8/1
Y1 - 2017/8/1
N2 - BACKGROUND: Patients with prostate cancer and their providers face uncertainty as they consider adjuvant radiotherapy (ART) or salvage radiotherapy (SRT) after undergoing radical prostatectomy. The authors prospectively evaluated the impact of the Decipher test, which predicts metastasis risk after radical prostatectomy, on decision making for ART and SRT. METHODS: A total of 150 patients who were considering ART and 115 who were considering SRT were enrolled. Providers submitted a management recommendation before processing the Decipher test and again at the time of receipt of the test results. Patients completed validated surveys on prostate cancer (PCa)-specific decisional effectiveness and PCa-related anxiety. RESULTS: Before the Decipher test, observation was recommended for 89% of patients considering ART and 58% of patients considering SRT. After Decipher testing, 18% (95% confidence interval [95% CI], 12%-25%) of treatment recommendations changed in the ART arm, including 31% among high-risk patients; and 32% (95% CI, 24%-42%) of management recommendations changed in the salvage arm, including 56% among high-risk patients. Decisional Conflict Scale (DCS) scores were better after viewing Decipher test results (ART arm: median DCS before Decipher, 25 and after Decipher, 19 [P<.001]; SRT arm: median DCS before Decipher, 27 and after Decipher, 23 [P<.001]). PCa-specific anxiety changed after Decipher testing; fear of PCa disease recurrence in the ART arm (P =.02) and PCa-specific anxiety in the SRT arm (P =.05) decreased significantly among low-risk patients. Decipher results reported per 5% increase in 5-year metastasis probability were associated with the decision to pursue ART (odds ratio, 1.48; 95% CI, 1.19-1.85) and SRT (odds ratio, 1.41; 95% CI, 1.09-1.81) in multivariable logistic regression analysis. CONCLUSIONS: Knowledge of Decipher test results was associated with treatment decision making and improved decisional effectiveness among men with PCa who were considering ART and SRT. Cancer 2017;123:2850–59.
AB - BACKGROUND: Patients with prostate cancer and their providers face uncertainty as they consider adjuvant radiotherapy (ART) or salvage radiotherapy (SRT) after undergoing radical prostatectomy. The authors prospectively evaluated the impact of the Decipher test, which predicts metastasis risk after radical prostatectomy, on decision making for ART and SRT. METHODS: A total of 150 patients who were considering ART and 115 who were considering SRT were enrolled. Providers submitted a management recommendation before processing the Decipher test and again at the time of receipt of the test results. Patients completed validated surveys on prostate cancer (PCa)-specific decisional effectiveness and PCa-related anxiety. RESULTS: Before the Decipher test, observation was recommended for 89% of patients considering ART and 58% of patients considering SRT. After Decipher testing, 18% (95% confidence interval [95% CI], 12%-25%) of treatment recommendations changed in the ART arm, including 31% among high-risk patients; and 32% (95% CI, 24%-42%) of management recommendations changed in the salvage arm, including 56% among high-risk patients. Decisional Conflict Scale (DCS) scores were better after viewing Decipher test results (ART arm: median DCS before Decipher, 25 and after Decipher, 19 [P<.001]; SRT arm: median DCS before Decipher, 27 and after Decipher, 23 [P<.001]). PCa-specific anxiety changed after Decipher testing; fear of PCa disease recurrence in the ART arm (P =.02) and PCa-specific anxiety in the SRT arm (P =.05) decreased significantly among low-risk patients. Decipher results reported per 5% increase in 5-year metastasis probability were associated with the decision to pursue ART (odds ratio, 1.48; 95% CI, 1.19-1.85) and SRT (odds ratio, 1.41; 95% CI, 1.09-1.81) in multivariable logistic regression analysis. CONCLUSIONS: Knowledge of Decipher test results was associated with treatment decision making and improved decisional effectiveness among men with PCa who were considering ART and SRT. Cancer 2017;123:2850–59.
KW - Decipher
KW - adjuvant therapy
KW - decisional conflict
KW - prostate cancer
KW - prostatectomy
KW - quality of life
KW - salvage therapy
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U2 - 10.1002/cncr.30665
DO - 10.1002/cncr.30665
M3 - Article
C2 - 28422278
AN - SCOPUS:85018547714
SN - 0008-543X
VL - 123
SP - 2850
EP - 2859
JO - Cancer
JF - Cancer
IS - 15
ER -