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Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study

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...

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Autores principales: Gore, John L., du Plessis, Marguerite, Santiago‐Jiménez, María, Yousefi, Kasra, Thompson, Darby J. S., Karsh, Lawrence, Lane, Brian R., Franks, Michael, Chen, David Y. T., Bandyk, Mark, Bianco, Fernando J., Brown, Gordon, Clark, William, Kibel, Adam S., Kim, Hyung L., Lowrance, William, Manoharan, Murugesan, Maroni, Paul, Perrapato, Scott, Sieber, Paul, Trabulsi, Edouard J., Waterhouse, Robert, Davicioni, Elai, Lotan, Yair, Lin, Daniel W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573983/
https://www.ncbi.nlm.nih.gov/pubmed/28422278
http://dx.doi.org/10.1002/cncr.30665
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author Gore, John L.
du Plessis, Marguerite
Santiago‐Jiménez, María
Yousefi, Kasra
Thompson, Darby J. S.
Karsh, Lawrence
Lane, Brian R.
Franks, Michael
Chen, David Y. T.
Bandyk, Mark
Bianco, Fernando J.
Brown, Gordon
Clark, William
Kibel, Adam S.
Kim, Hyung L.
Lowrance, William
Manoharan, Murugesan
Maroni, Paul
Perrapato, Scott
Sieber, Paul
Trabulsi, Edouard J.
Waterhouse, Robert
Davicioni, Elai
Lotan, Yair
Lin, Daniel W.
author_facet Gore, John L.
du Plessis, Marguerite
Santiago‐Jiménez, María
Yousefi, Kasra
Thompson, Darby J. S.
Karsh, Lawrence
Lane, Brian R.
Franks, Michael
Chen, David Y. T.
Bandyk, Mark
Bianco, Fernando J.
Brown, Gordon
Clark, William
Kibel, Adam S.
Kim, Hyung L.
Lowrance, William
Manoharan, Murugesan
Maroni, Paul
Perrapato, Scott
Sieber, Paul
Trabulsi, Edouard J.
Waterhouse, Robert
Davicioni, Elai
Lotan, Yair
Lin, Daniel W.
author_sort Gore, John L.
collection PubMed
description 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. © 2017 American Cancer Society.
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spelling pubmed-55739832017-09-15 Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study Gore, John L. du Plessis, Marguerite Santiago‐Jiménez, María Yousefi, Kasra Thompson, Darby J. S. Karsh, Lawrence Lane, Brian R. Franks, Michael Chen, David Y. T. Bandyk, Mark Bianco, Fernando J. Brown, Gordon Clark, William Kibel, Adam S. Kim, Hyung L. Lowrance, William Manoharan, Murugesan Maroni, Paul Perrapato, Scott Sieber, Paul Trabulsi, Edouard J. Waterhouse, Robert Davicioni, Elai Lotan, Yair Lin, Daniel W. Cancer Original Articles 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. © 2017 American Cancer Society. John Wiley and Sons Inc. 2017-04-19 2017-08-01 /pmc/articles/PMC5573983/ /pubmed/28422278 http://dx.doi.org/10.1002/cncr.30665 Text en © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Gore, John L.
du Plessis, Marguerite
Santiago‐Jiménez, María
Yousefi, Kasra
Thompson, Darby J. S.
Karsh, Lawrence
Lane, Brian R.
Franks, Michael
Chen, David Y. T.
Bandyk, Mark
Bianco, Fernando J.
Brown, Gordon
Clark, William
Kibel, Adam S.
Kim, Hyung L.
Lowrance, William
Manoharan, Murugesan
Maroni, Paul
Perrapato, Scott
Sieber, Paul
Trabulsi, Edouard J.
Waterhouse, Robert
Davicioni, Elai
Lotan, Yair
Lin, Daniel W.
Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study
title Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study
title_full Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study
title_fullStr Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study
title_full_unstemmed Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study
title_short Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO‐IMPACT study
title_sort decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: interim results from the multicenter prospective pro‐impact study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573983/
https://www.ncbi.nlm.nih.gov/pubmed/28422278
http://dx.doi.org/10.1002/cncr.30665
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