A molecular test could sharpen treatment choices
Doctors treating high-risk, localized prostate cancer face a persistent dilemma: some patients may benefit substantially from more intensive therapy, while others may be exposed to additional side effects without a comparable gain. New findings presented by researchers at University College London suggest that a tissue-based molecular test, Decipher, may help distinguish between those groups.
The work draws on data associated with the STAMPEDE clinical trial, which has examined treatment approaches for prostate cancer. The researchers evaluated whether Decipher scores could identify patients most likely to benefit from adding the hormone therapy abiraterone to standard treatment.
Abiraterone has already shown promise in the high-risk localized setting. UCL researchers said prior STAMPEDE findings showed that adding it to standard treatment could halve the risk of death from the disease and slow overall progression for men with high-risk, localized prostate cancer. But intensified treatment is not automatically appropriate for every patient, and other trials of added hormonal therapies have not consistently shown a benefit.
What the Decipher analysis found
Decipher is a tissue-based molecular test intended to provide a score associated with the biological behavior of a tumor. In the new analysis, the UCL team examined scores in two datasets: real-world data from 27,607 men, including 5,956 analyzed for outcomes, and 401 men with non-metastatic prostate cancer who had been randomized in the STAMPEDE abiraterone trial.
Higher Decipher scores consistently tracked with worse outcomes. For each 0.1 increase in score, the adjusted hazard ratio for distant metastasis was 1.49, while the hazard ratio for death from prostate cancer was 1.38, according to the researchers.
The score also appeared to identify which patients whose cancer had not spread to lymph nodes would benefit from abiraterone in preventing spread to distant sites. That finding is potentially important because preventing metastatic spread is a central objective in men with very high-risk disease.
Why treatment selection matters
Prostate cancer does not follow a single course. Patients with apparently similar diagnoses can have materially different risks of progression, and treatment decisions often involve weighing possible survival or disease-control benefits against effects on quality of life.
More aggressive treatment can bring more side effects. The source notes that fatigue is among the side effects associated with abiraterone. A test that improves the ability to identify patients with the most to gain could therefore support more individualized discussions between clinicians and patients.
The results do not mean that the test alone should determine treatment. They instead add evidence that molecular information may complement established clinical assessments when clinicians consider intensified therapy for high-risk localized disease.
What comes next
The findings were presented at a major cancer conference in Madrid and describe an analysis involving trial and real-world datasets. The results support further evaluation of how Decipher-guided treatment decisions could be incorporated into care for high-risk localized prostate cancer.
For now, the practical significance is the prospect of a more precise way to match intensified hormonal therapy with the patients most likely to benefit. In a disease where overtreatment can carry lasting costs, better risk stratification could help make the balance between disease control and treatment burden more informed.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
