title: Impact of a Genomic Classifier of Metastatic Risk on Postprostatectomy Treatment Recommendations by Radiation Oncologists and Urologists.
abstract: OBJECTIVE
  To evaluate how a genomic classifier (GC) that predicts the risk of metastasis after prostatectomy would impact adjuvant treatment recommendations made by radiation oncologists and urologists. The 2 specialties often disagree about postprostatectomy adjuvant treatment recommendations.
  
  
  METHODS
  Twenty-six radiation oncologists and 20 urologists with genitourinary oncology expertise reviewed de-identified clinical results from 11 patients after radical prostatectomy and made adjuvant treatment recommendations. The same cases were later randomized and reassigned, 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 < .0001). The GC test results altered 35% and 45% of treatment recommendations made by radiation oncologists and urologists, respectively. Multivariate analysis showed GC risk was the strongest factor influencing treatment recommendations by both specialties, with an adjusted odds ratio of 4.17 (95% confidence interval [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, whereas 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 postprostatectomy treatment recommendations, reduced disagreement between radiation oncologists and urologists, and has the potential to enhance personalization of postprostatectomy care.
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School, Boston, MA. Electronic address: pnguyen@LROC.harvard.edu.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: GenomeDx Biosciences, Vancouver, British Columbia, Canada.
authors.forename: Heesun
authors.initials: H
authors.lastname: Shin
authors.affiliation: GenomeDx Biosciences, Vancouver, British Columbia, Canada.
authors.forename: Kasra
authors.initials: K
authors.lastname: Yousefi
authors.affiliation: EMMES Canada, Burnaby, British Columbia, Canada.
authors.forename: Darby J
authors.initials: DJ
authors.lastname: Thompson
authors.affiliation: Cedar Associates, Menlo Park, CA; Department of Medicine, Stanford University, Stanford, CA.
authors.forename: John
authors.initials: J
authors.lastname: Hornberger
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center and Harvard Medical School, Boston, MA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Hyatt
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY.
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Morgan
authors.affiliation: Radiation Oncology, University of Michigan, Ann Arbor, MI.
authors.forename: Felix Y
authors.initials: FY
authors.lastname: Feng
mesh_terms: D023281:Genomics / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011182:Postoperative Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D018787:Radiation Oncology; D014572:Urology