Genomic Prostate Score: A New Tool to Assess Prognosis and Optimize Radiation Therapy Volumes and ADT in Intermediate-Risk Prostate Cancer

SIMPLE SUMMARY: Current standard clinical risk-stratification systems do not sufficiently reflect the disease heterogeneity for prostate cancer. Intermediate risk prostate cancer represents a highly heterogeneous risk group with different treatment options available such as surgery, radiation therapy and hormone therapy. Genomic Prostate Score which can obtained from prostate core biopsies could help to personalize treatment for men with intermediate-risk prostate cancer. The main aim of this present prospective study was to assess the impact of Genomic Prostate Score when compared to clinical risk factors alone in this population. This research study demonstrated that use of Genomic Prostate Score in a series of 30 patients with intermediate risk prostate cancer resulted in major shift in risk groups in most patients. This genomic score represents a potential impactful tool for treatment decision and better personalization of treatment for patients with intermediate risk in daily practice. ABSTRACT: Genomic classifiers such as the Genomic Prostate Score (GPS) could help to personalize treatment for men with intermediate-risk prostate cancer (I-PCa). In this study, we aimed to evaluate the ability of the GPS to change therapeutic decision making in I-PCa. Only patients in the intermediate NCCN risk group with Gleason score 3 + 4 were considered. The primary objective was to assess the impact of the GPS on risk stratification: NCCN clinical and genomic risk versus NCCN clinical risk stratification alone. We also analyzed the predictive role of the GPS for locally advanced disease (≥pT3+) and the potential change in treatment strategy. Thirty patients were tested for their GPS between November 2018 and March 2020, with the median age being 70 (45–79). Twenty-three patients had a clinical T1 stage. Eighteen patients were classified as favorable intermediate risk (FIR) based on the NCCN criteria. The median GPS score was 39 (17–70). Among the 23 patients who underwent a radical prostatectomy, Gleason score 3 + 4 was found in 18 patients. There was a significant correlation between the GPS and the percentage of a Gleason grade 4 or higher pattern in the surgical sample: correlation coefficient r = 0.56; 95% CI = 0.2–0.8; p = 0.005. In this study, the GPS combined with NCCN clinical risk factors resulted in significant changes in risk group.