Moffitt Cancer Center study demonstrates Decipher classifier’s effectiveness in predicting early recurrence, particularly in underrepresented patient population.
A genomic test widely used in prostate cancer care can more accurately identify which men with early-stage disease face high risk of recurrence after treatment, with particularly strong results in African American patients who have historically been underrepresented in genomic research, according to a new study from Moffitt Cancer Center.
The VANDAAM study, published in the Journal of the National Comprehensive Cancer Network, evaluated the Decipher genomic classifier in 243 men with early-stage prostate cancer treated between 2016 and 2021. The study included equal numbers of African American and white participants with similar clinical risk profiles at diagnosis.
Results showed that men with high genomic-risk Decipher scores were approximately five times more likely to experience PSA rise within two years compared to those with low-risk scores. Among African American men specifically, high genomic-risk scores correlated with roughly 17 times higher odds of early recurrence, and every African American patient who experienced recurrence fell into the high genomic-risk category.
“One of the most important messages from this study is that genomic risk information adds useful detail on top of the tools clinicians already use,” says Kosj Yamoah, MD, PhD, principal investigator and chair of the radiation oncology department at Moffitt, in a release. “For African American men with early prostate cancer, this test helped separate a small group with rapid recurrence from the large group who remained cancer-free at two years.”
Addressing Disparities in Prostate Cancer Research
African American men face a disproportionate prostate cancer burden, with approximately 73% higher incidence rates and 23% higher mortality compared to white men. Despite these disparities, this population has been underrepresented in genomic research that informs treatment guidelines.
The study focused on 207 men with complete test results and follow-up data, including 104 African American and 103 white participants. All patients received standard-of-care treatment with either surgery or definitive radiotherapy with or without short-term hormone therapy, followed by regular PSA monitoring for two years.
Researchers found the correlation between high genomic-risk scores and early recurrence appeared similar in both African American and white men, as well as across different treatment modalities. By combining genomic scores with routine clinical information, researchers could accurately distinguish African American men whose cancer recurred within two years from those who remained recurrence-free.
Clinical Implementation Insights
The study revealed that approximately three out of four men who underwent Decipher testing on both biopsy tissue and surgically removed prostate tissue received the same risk category classification. This finding suggests biopsy-based testing alone can often provide reliable pre-treatment guidance.
In cases where tumors showed higher genomic risk after surgery, cancers located in the anterior prostate were more likely to be upgraded, indicating areas that routine biopsies may not adequately sample.
A subset of African American tumors displayed distinctive genomic patterns characterized by increased immune activity and reduced DNA repair signals, potentially explaining why some African American patients respond particularly well to radiotherapy.
“These data support using genomic testing earlier in care to better match African American patients with the treatment intensity and type that fit the biology of their tumor,” says Yamoah in a release. “It is one practical step toward narrowing long-standing differences in prostate cancer outcomes.”
Study Limitations and Future Directions
With only 15 men experiencing cancer recurrence during the two-year follow-up period, researchers acknowledge that larger studies with more diverse participants will help refine risk estimates and track longer-term outcomes including cancer spread and survival rates.
The investigators suggest Decipher genomic testing can be incorporated into routine risk assessment to help identify African American men with early localized prostate cancer who may require closer monitoring or more intensive treatment approaches.
The research was supported by the National Institutes of Health, Prostate Cancer Foundation, and George Edgecomb Society.
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