Introduction

Prostate cancer patients and providers have tremendous uncertainty as they decide on the appropriate timing for intervention with adjuvant or salvage radiation therapy (ART, SRT) after radical prostatectomy (RP). We prospectively evaluated the impact of the Decipher test (GenomeDx Biosciences Inc., San Diego), which predicts metastasis risk after RP, on providers' decision-making for ART and SRT.

Methods

150 patients considering ART and 115 patients considering SRT were enrolled. Participating providers submitted a management recommendation prior to processing the Decipher test and again upon receiving the Decipher test results. Patients completed validated surveys on prostate cancer-specific quality of life, decision quality, and prostate cancer-related anxiety.

Results

Pre-Decipher, observation was recommended for 89% of adjuvant patients and 58% of salvage patients. Post-Decipher, 18% (95% CI 12-25%) of treatment recommendations changed in the adjuvant arm, including 31% of high-risk Decipher patients, and 32% (95% CI 24-42%) of management recommendations changed in the salvage arm, including 56% of high-risk Decipher patients. Decisional Conflict Scale (DCS) scores decreased (indicating higher decision quality) after exposure to Decipher results (median DCS pre-Decipher 25 [IQR 8-44], median DCS post-Decipher 19 [IQR 2-30], p<0.001 in the adjuvant arm, pre-Decipher 27 [IQR 16-41], post-Decipher 23 [IQR 4-30], p<0.001 in the salvage arm). Prostate cancer-specific anxiety changed following exposure to Decipher test results: fear of prostate cancer recurrence in the adjuvant arm (p=0.02) and prostate cancer-specific anxiety in the salvage arm (p=0.05) decreased significantly among Decipher low-risk patients. Decipher results were associated with the decision to pursue ART (OR 1.48; 95% CI 1.19-1.85) and SRT (OR 1.41; 95% CI 1.09-1.81) in multivariable logistic regression. _x000D_

Conclusions

Knowledge of Decipher results was associated with treatment decision-making and improved decision quality among men with prostate cancer considering adjuvant or salvage radiation therapy.

Funding

GenomeDx Biosciences Inc.