Utilization of a Genomic Classifier for Prediction of Metastasis Following Salvage Radiation Therapy after Radical Prostatectomy

Stephen J. Freedland, Voleak Choeurng, Lauren Howard, Amanda De Hoedt, Marguerite du Plessis, Kasra Yousefi, Lucia L. Lam, Christine Buerki, Seong Ra, Bruce Robbins, Edouard J. Trabulsi, Nikhil L. Shah, Firas Abdollah, Felix Y. Feng, Elai Davicioni, Adam P. Dicker, Robert J. Karnes, Robert B. Den

Research output: Contribution to journalArticlepeer-review

59 Scopus citations

Abstract

Background Despite salvage radiation therapy (SRT) for recurrent prostate cancer (PCa) after radical prostatectomy (RP), some patients still progress to metastases. Identifying these men would allow them to undergo systemic therapy including testing novel therapies to reduce metastases risk. Objective To test whether the genomic classifier (GC) predicts development of metastatic disease. Design, setting, and participants Retrospective multi-center and multi-ethnic cohort study from two academic centers and one Veterans Affairs Medical Center in the United States involving 170 men receiving SRT for recurrent PCa post-RP. Outcome measurements and statistical analysis Time from SRT to development of metastatic disease tested using Cox regression, survival c-index, and decision curve analysis. Performance of GC was compared to the Cancer of the Prostate Risk Assessment Score and Briganti risk models based on these metrics. Results and limitations With a median 5.7 yr follow-up after SRT, 20 patients (12%) developed metastases. On multivariable analysis, for each 0.1 unit increase in GC (scaled from 0 to 1), the hazard ratio for metastasis was 1.58 (95% confidence interval 1.16–2.17; p = 0.002). Adjusting for androgen deprivation therapy did not materially change the results. The c-index for GC was 0.85 (95% confidence interval 0.73–0.88) versus 0.63–0.65 for published clinico-pathologic risk models. The 5-yr cumulative incidence of metastasis post-SRT in patients with low, intermediate, and high GC scores was 2.7%, 8.4%, and 33.1%, respectively (p < 0.001). Conclusions While validation in larger, prospectively collected cohorts is required, these data suggest GC is a strong predictor of metastases among men receiving SRT for recurrent PCa post-RP, accurately identifying men who are excellent candidates for systemic therapy due to their very high-risk of metastases. Patient summary Genomic classifier and two clinico-pathologic risk models were evaluated on their ability to predict metastases among men receiving salvage radiation therapy for recurrent prostate cancer. Genomic classifier was able to identify candidates for further therapies due to their very high-risk of metastases.

Original languageEnglish (US)
Pages (from-to)588-596
Number of pages9
JournalEuropean urology
Volume70
Issue number4
DOIs
StatePublished - Oct 1 2016

Keywords

  • Genomic classifier
  • Metastasis
  • Prognosis
  • Prostate cancer
  • Salvage radiation therapy

ASJC Scopus subject areas

  • Urology

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