Prostate Cancer Tumor Volume and Genomic Risk

Ashwin Ramaswamy; James A. Proudfoot; Ashley E. Ross; Elai Davicioni; Edward M. Schaeffer; Jim C. Hu

doi:10.1016/j.euros.2022.12.002

Prostate Cancer Tumor Volume and Genomic Risk

Ashwin Ramaswamy, James A. Proudfoot, Ashley E. Ross, Elai Davicioni, Edward M. Schaeffer, Jim C. Hu^*

^*Corresponding author for this work

Urology

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Despite the historic association of higher prostate cancer volume with worse oncologic outcomes, little is known about the impact of tumor volume on cancer biology. Objective: To characterize the relationship between tumor volume (measured by percent positive cores [PPC]) and cancer biology (measured by Decipher genomic risk classifier [GC]) in men who underwent prostate biopsy. Design, setting, and participants: Prostate biopsies from 52 272 men profiled with Decipher captured in a population-based prospective tumor registry were collected from 2016 to 2021. Outcome measurements and statistical analysis: The degree of distribution and correlation of PPC with a GC score across grade group (GG) strata were examined using the Mann-Whitney U test, Pearson correlation coefficient, and multivariable linear regression controlled for clinicopathologic characteristics. Results and limitations: A total of 38 921 (74%) biopsies passed quality control (14 331 GG1, 16 159 GG2, 5661 GG3, 1775 GG4, and 995 GG5). Median PPC and GC increased with sequentially higher GG. There was an increasingly positive correlation (r) between PPC and GC in GG2–5 prostate cancer (r [95% confidence interval {CI}]: 0.07 [0.5, 0.8] in GG2, 0.15 [0.12, 0.17] in GG3, 0.20 [0.15, 0.24] in GG4, and 0.25 [0.19, 0.31] in GG5), with no correlation in GG1 disease (r = 0.01, 95% CI [–0.001, 0.03]). In multivariable linear regression, GC was significantly associated with higher PPC for GG2–5 (all p < 0.05) but was not significantly associated with PPC for GG1. Limitations include retrospective design and a lack of final pathology from radical prostatectomy specimens. Conclusions: Higher tumor volume was associated with worse GC for GG2–5 prostate cancer, whereas tumor volume was not associated with worse GC for GG1 disease. The finding that tumor volume is not associated with worse cancer biology in GG1 disease encourages active surveillance for most patients irrespective of tumor volume. Patient summary: We studied the relationship between prostate cancer tumor volume and cancer biology, as measured by the Decipher genomic risk score, in men who underwent prostate biopsy. We found that tumor volume was not associated with worse cancer biology for low-grade prostate cancer. Our findings reassuringly support recent guidelines to recommend active surveillance for grade group 1 prostate cancer in most patients, irrespective of tumor volume.

Original language	English (US)
Pages (from-to)	90-97
Number of pages	8
Journal	European Urology Open Science
Volume	48
DOIs	https://doi.org/10.1016/j.euros.2022.12.002
State	Published - Feb 2023

Funding

Financial disclosures: Ashwin Ramaswamy certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Ashwin Ramaswamy reports no conflicts of interest. James A. Proudfoot is an employee of Veracyte, Inc., which has rights to the Decipher genomic classifier assay and maintains the Decipher GRID database. Ashley E. Ross is a consultant for Veracyte, Inc.; Astellas, Inc.; Bayer, Inc.; Blue Earth, Inc.; Janssen, Inc.; and Tempus, Inc. Elai Davicioni is an employee of Veracyte, Inc., which has rights to the Decipher genomic classifier assay and maintains the Decipher GRID database. Edward M. Schaeffer is a consultant for Pfizer, Inc.; Astellas, Inc.; and Lantheus, Inc.; as well as receiving salary support from NIH R01CA241758 and NIH R01CA259173. Jim C. Hu receives research support from the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust, as well as receiving salary support from NIH R01CA241758, NIH R01CA259173, Prostate Cancer Foundation, PCORI CER-2019C1-15682, and CER-2019C2-17372. Funding/Support and role of the sponsor: This work was supported by Veracyte Inc.

Keywords

Active surveillance
Biomarker
Decipher
Genomic risk classifier
Prostate cancer
Risk stratification
Tumor volume

ASJC Scopus subject areas

Urology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.euros.2022.12.002

Cite this

@article{263e47fc7df04f969ecbad2b3808b55a,

title = "Prostate Cancer Tumor Volume and Genomic Risk",

abstract = "Background: Despite the historic association of higher prostate cancer volume with worse oncologic outcomes, little is known about the impact of tumor volume on cancer biology. Objective: To characterize the relationship between tumor volume (measured by percent positive cores [PPC]) and cancer biology (measured by Decipher genomic risk classifier [GC]) in men who underwent prostate biopsy. Design, setting, and participants: Prostate biopsies from 52 272 men profiled with Decipher captured in a population-based prospective tumor registry were collected from 2016 to 2021. Outcome measurements and statistical analysis: The degree of distribution and correlation of PPC with a GC score across grade group (GG) strata were examined using the Mann-Whitney U test, Pearson correlation coefficient, and multivariable linear regression controlled for clinicopathologic characteristics. Results and limitations: A total of 38 921 (74%) biopsies passed quality control (14 331 GG1, 16 159 GG2, 5661 GG3, 1775 GG4, and 995 GG5). Median PPC and GC increased with sequentially higher GG. There was an increasingly positive correlation (r) between PPC and GC in GG2–5 prostate cancer (r [95% confidence interval {CI}]: 0.07 [0.5, 0.8] in GG2, 0.15 [0.12, 0.17] in GG3, 0.20 [0.15, 0.24] in GG4, and 0.25 [0.19, 0.31] in GG5), with no correlation in GG1 disease (r = 0.01, 95% CI [–0.001, 0.03]). In multivariable linear regression, GC was significantly associated with higher PPC for GG2–5 (all p < 0.05) but was not significantly associated with PPC for GG1. Limitations include retrospective design and a lack of final pathology from radical prostatectomy specimens. Conclusions: Higher tumor volume was associated with worse GC for GG2–5 prostate cancer, whereas tumor volume was not associated with worse GC for GG1 disease. The finding that tumor volume is not associated with worse cancer biology in GG1 disease encourages active surveillance for most patients irrespective of tumor volume. Patient summary: We studied the relationship between prostate cancer tumor volume and cancer biology, as measured by the Decipher genomic risk score, in men who underwent prostate biopsy. We found that tumor volume was not associated with worse cancer biology for low-grade prostate cancer. Our findings reassuringly support recent guidelines to recommend active surveillance for grade group 1 prostate cancer in most patients, irrespective of tumor volume.",

keywords = "Active surveillance, Biomarker, Decipher, Genomic risk classifier, Prostate cancer, Risk stratification, Tumor volume",

author = "Ashwin Ramaswamy and Proudfoot, {James A.} and Ross, {Ashley E.} and Elai Davicioni and Schaeffer, {Edward M.} and Hu, {Jim C.}",

note = "Publisher Copyright: {\textcopyright} 2022",

year = "2023",

month = feb,

doi = "10.1016/j.euros.2022.12.002",

language = "English (US)",

volume = "48",

pages = "90--97",

journal = "European Urology Open Science",

issn = "2666-1691",

publisher = "Elsevier BV",

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TY - JOUR

T1 - Prostate Cancer Tumor Volume and Genomic Risk

AU - Ramaswamy, Ashwin

AU - Proudfoot, James A.

AU - Ross, Ashley E.

AU - Davicioni, Elai

AU - Schaeffer, Edward M.

AU - Hu, Jim C.

PY - 2023/2

Y1 - 2023/2

N2 - Background: Despite the historic association of higher prostate cancer volume with worse oncologic outcomes, little is known about the impact of tumor volume on cancer biology. Objective: To characterize the relationship between tumor volume (measured by percent positive cores [PPC]) and cancer biology (measured by Decipher genomic risk classifier [GC]) in men who underwent prostate biopsy. Design, setting, and participants: Prostate biopsies from 52 272 men profiled with Decipher captured in a population-based prospective tumor registry were collected from 2016 to 2021. Outcome measurements and statistical analysis: The degree of distribution and correlation of PPC with a GC score across grade group (GG) strata were examined using the Mann-Whitney U test, Pearson correlation coefficient, and multivariable linear regression controlled for clinicopathologic characteristics. Results and limitations: A total of 38 921 (74%) biopsies passed quality control (14 331 GG1, 16 159 GG2, 5661 GG3, 1775 GG4, and 995 GG5). Median PPC and GC increased with sequentially higher GG. There was an increasingly positive correlation (r) between PPC and GC in GG2–5 prostate cancer (r [95% confidence interval {CI}]: 0.07 [0.5, 0.8] in GG2, 0.15 [0.12, 0.17] in GG3, 0.20 [0.15, 0.24] in GG4, and 0.25 [0.19, 0.31] in GG5), with no correlation in GG1 disease (r = 0.01, 95% CI [–0.001, 0.03]). In multivariable linear regression, GC was significantly associated with higher PPC for GG2–5 (all p < 0.05) but was not significantly associated with PPC for GG1. Limitations include retrospective design and a lack of final pathology from radical prostatectomy specimens. Conclusions: Higher tumor volume was associated with worse GC for GG2–5 prostate cancer, whereas tumor volume was not associated with worse GC for GG1 disease. The finding that tumor volume is not associated with worse cancer biology in GG1 disease encourages active surveillance for most patients irrespective of tumor volume. Patient summary: We studied the relationship between prostate cancer tumor volume and cancer biology, as measured by the Decipher genomic risk score, in men who underwent prostate biopsy. We found that tumor volume was not associated with worse cancer biology for low-grade prostate cancer. Our findings reassuringly support recent guidelines to recommend active surveillance for grade group 1 prostate cancer in most patients, irrespective of tumor volume.

AB - Background: Despite the historic association of higher prostate cancer volume with worse oncologic outcomes, little is known about the impact of tumor volume on cancer biology. Objective: To characterize the relationship between tumor volume (measured by percent positive cores [PPC]) and cancer biology (measured by Decipher genomic risk classifier [GC]) in men who underwent prostate biopsy. Design, setting, and participants: Prostate biopsies from 52 272 men profiled with Decipher captured in a population-based prospective tumor registry were collected from 2016 to 2021. Outcome measurements and statistical analysis: The degree of distribution and correlation of PPC with a GC score across grade group (GG) strata were examined using the Mann-Whitney U test, Pearson correlation coefficient, and multivariable linear regression controlled for clinicopathologic characteristics. Results and limitations: A total of 38 921 (74%) biopsies passed quality control (14 331 GG1, 16 159 GG2, 5661 GG3, 1775 GG4, and 995 GG5). Median PPC and GC increased with sequentially higher GG. There was an increasingly positive correlation (r) between PPC and GC in GG2–5 prostate cancer (r [95% confidence interval {CI}]: 0.07 [0.5, 0.8] in GG2, 0.15 [0.12, 0.17] in GG3, 0.20 [0.15, 0.24] in GG4, and 0.25 [0.19, 0.31] in GG5), with no correlation in GG1 disease (r = 0.01, 95% CI [–0.001, 0.03]). In multivariable linear regression, GC was significantly associated with higher PPC for GG2–5 (all p < 0.05) but was not significantly associated with PPC for GG1. Limitations include retrospective design and a lack of final pathology from radical prostatectomy specimens. Conclusions: Higher tumor volume was associated with worse GC for GG2–5 prostate cancer, whereas tumor volume was not associated with worse GC for GG1 disease. The finding that tumor volume is not associated with worse cancer biology in GG1 disease encourages active surveillance for most patients irrespective of tumor volume. Patient summary: We studied the relationship between prostate cancer tumor volume and cancer biology, as measured by the Decipher genomic risk score, in men who underwent prostate biopsy. We found that tumor volume was not associated with worse cancer biology for low-grade prostate cancer. Our findings reassuringly support recent guidelines to recommend active surveillance for grade group 1 prostate cancer in most patients, irrespective of tumor volume.

KW - Active surveillance

KW - Biomarker

KW - Decipher

KW - Genomic risk classifier

KW - Prostate cancer

KW - Risk stratification

KW - Tumor volume

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Prostate Cancer Tumor Volume and Genomic Risk

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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