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Genomic Markers in Prostate Cancer Decision
MakingRafael F. Coelho MD, PhD
Chief of Urologic Oncology - University of São Paulo, Brazil
Director of Prostate Cancer Department, Brazilian Society of Urology
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Pre-treatment Risk stratification
biomarkers
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Oncotype DX
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Oncotype DX
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Oncotype DX
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Oncotype DX
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Oncotype DX
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Oncotype
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Oncotype DX
130 • Vol. 18 No. 3 • 2016 • Reviews in Urology
Incorporation of the GenomicProstate Score (GPS) as part of thedecision algorithm for patients withvery low risk and low-risk cancer ledto substantial increase in uptake ofAS and substantial cost savings.
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Prolaris
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Prolaris
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Prolaris
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Prolaris
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Prolaris
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Prolaris
The CCP test has a significant impact in assistingphysicians and patients reach personalizedtreatment decisions
S0022-5347(15)04811-9 DOI: 10.1016/j.juro.2015.09.072
mean number of treatments per patient decreasing from 1.72 pre-CCP test to 1.16
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Prolaris
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Decipher
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Decipher
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Decipher
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Decipher
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Decipher
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Cucchiara V, et al. Genomic Markers in Prostate Cancer Decision Making. Eur Urol(2017),
Pre-treatment Risk stratification biomarkers
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Wagner J, et al "Prostate cancer genomics: Comparing Decipher, Prolaris, and Oncotype DX Results" AUA 2018; Abstract PD06-09.
A favorable prediction for each was defined as follows:
• Decipher and Prolaris: likelihood of 10 year PCM= 3%; • Oncotype DX: >70% likelihood of organ confined, Grade Group 1 or 2
Decipher – Prolaris agreement = 67%Prolaris – Oncotype =75%Decipher - Oncotype = 50%
Decipher – NCCN= 60%Prolaris – NCCN =75%Oncotype – NCCN = 50%
Vol. 199, No. 4S, Supplement, Friday, May 18, 2018
Notable differences exist in favorable prognostic outcomes obtainedfrom OncotypeDx, Prolaris, and Decipher. Prolaris is most apt toconfirm NCCN recommendation while Oncotype DX is more likely togo against it
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Briganti et al. Eur Urol. 2018
Biological markers, appear promising to guide care of men with AS. However, they have not yet been prospectively robustly
tested in the AS setting. Therefore, while waiting for further data and even though some men may benefit for assessment of these
biomarkers, their use cannot be currently routinely recommended in AS.
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Post-treatment Risk stratification
biomarkers
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In patients treated with post-RP RT, GC is prognostic for the development of clinicalmetastasis beyond routine clinical and pathologic features. Pts with low GC scores are besttreated with salvage RT, whereas those with high GC scores benefit from adjuvant therapy
J Clin Oncol 33:944-951. © 2015
>0.4
23%
6%
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In patients treated with post-RP RT, GC is prognostic for the development of clinicalmetastasis beyond routine clinical and pathologic features. Pts with low GC scores are besttreated with salvage RT, whereas those with high GC scores benefit from adjuvant therapy
J Clin Oncol 33:944-951. © 2015
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Cancer August 1, 2017
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.
Adjuvant - 18% change
Salvage - 32% change
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Prostate Cancer Biomarkers
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Genomics in Michigan Impacting Observation or Radiation (G-MINOR)
NCT02783950
Number of participants that receive adjuvant therapy (radiation and/or hormone therapy)
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Genomic make-up varies widely among CaP foci, so care should be takenwhen making treatment decisions based on a single biopsy or indexlesions
Eur Urol. 2017 February ; 71(2): 183–192
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