Impact of a Genomic Classifier of Metastatic Risk on Post Prostatectomy Treatment Recommendations by Radiation Oncologists and Urologists
Year of Publication
Nguyen, PL; Shin, H; Yousefi, K; Thompson, DJ; Hornberger, J; Hyatt, AS; Badani, KK; Morgan, T; Feng, FY
International Journal of Radiation Oncology • Biology • Physics
Purpose/Objective(s) Radiation oncologists and urologists often disagree about post-prostatectomy adjuvant treatment recommendations. We studied how a genomic classifier (GC) that predicts the risk of metastasis after prostatectomy would impact adjuvant treatment recommendations made by specialists. Materials/Methods Twenty-six radiation oncologists and 20 urologists with genitourinary oncology expertise reviewed de-identified clinical results from 11 patients following radical prostatectomy and made adjuvant treatment recommendations. The same cases were later randomized and re-assigned, and treatment recommendations were made using the clinical information and GC test results together. Results Using clinical information alone, observation was recommended in 42% of decisions made by urologists vs. 23% by radiation oncologists (p<0.0001). The GC test results altered 35% and 45% of treatment recommendations made by radiation oncologists and urologists, respectively. Multivariable analysis showed GC risk was the strongest factor influencing treatment recommendations by both specialties, with an adjusted odds ratio (OR) of 4.17 (95% CI: 2.26-7.70) and 6.51 (95% CI: 4.29-9.88) for radiation oncologists and urologists, respectively. GC results indicating high metastatic risk resulted in intensification of treatment, while low metastatic risk resulted in less aggressive recommendations. The GC results increased interdisciplinary agreement in treatment recommendations, as the odds of a recommendation for adjuvant treatment by urologists vs. radiation oncologists increased from 0.27 (95% CI: 0.17-0.44) to 0.46 (95% CI: 0.29-0.75) after results of the GC test were available. Conclusions The GC test significantly influenced adjuvant post-prostatectomy treatment recommendations, reduced disagreement between radiation oncologists and urologists, and has the potential to enhance personalization of post-prostatectomy care.