A genomic classifier to identify men with adverse pathology post radical prostatectomy who benefit from adjuvant radiation therapy.

Authors

null

Robert Benjamin Den

Department of Radiation Oncology, The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA

Robert Benjamin Den , Kasra Yousefi , Edouard John Trabulsi , Firas Abdollah , Voleak Choeurng , Felix Yi-Chung Feng , Adam Dicker , Costas D. Lallas , Leonard G. Gomella , Elai Davicioni , R. Jeffrey Karnes

Organizations

Department of Radiation Oncology, The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, GenomeDx Biosciences, Inc., Vancouver, BC, Canada, The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, Department of Urology, Vita-Salute San Raffaele Hospital, Milan, Italy, Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, Department of Urology, Mayo Clinic, Rochester, MN, Rochester, MN

Research Funding

No funding sources reported

Background: The optimal timing of postoperative radiotherapy following radical prostatectomy (post-RP RT) is unclear. We hypothesized that a genomic classifier (GC) would provide prognostic and predictive insight into the development of clinical metastases in men receiving post-RP RT and inform decision-making. Methods: GC scores were calculated from 188 patients with pT3 or margin positive PCa, who received post-RP RT at Thomas Jefferson University and Mayo Clinic, between 1990 and 2009. The primary endpoint was clinical metastasis. Prognostic accuracy of the models were tested using c-index and decision curve analysis. Cox regression tested the relationship between GC and metastasis. Results: The cumulative incidence of metastasis at 5 years post-RT was 0%, 9%, and 29% for low, average, and high GC scores, respectively (p=0.002). In multivariable analysis, GC and pre-RP PSA were independent predictors of metastasis (both p<0.01). Within the low GC score (<0.4), there were no differences in the cumulative incidence of metastasis comparing those who received adjuvant or salvage RT (p=0.79). However, for patients with higher GC scores (≥0.4) cumulative incidence of metastasis at 5-year was 6% vs. 23% for patients treated with adjuvant vs. salvage RT (p<0.01). Conclusions: In patients treated with post-RP RT, GC is prognostic for the development of clinical metastasis beyond routine clinical/pathologic features. Though preliminary, patients with low GC are best treated with salvage radiation, while those with high GC benefit from adjuvant therapy. These findings provide the first rationale selection of timing of post-RP RT.

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Abstract Details

Meeting

2015 Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

General Poster Session A: Prostate Cancer

Track

Prostate Cancer

Sub Track

Prostate Cancer - Advanced Disease

Citation

J Clin Oncol 33, 2015 (suppl 7; abstr 168)

DOI

10.1200/jco.2015.33.7_suppl.168

Abstract #

168

Poster Bd #

H4

Abstract Disclosures