title: Validation of a Genomic Classifier for Predicting Post-Prostatectomy Recurrence in a Community Based Health Care Setting.
abstract: We determined the value of Decipher®, a genomic classifier, to predict prostate cancer outcomes among patients after prostatectomy in a community health care setting.
  
  
  
  We examined the experience of 224 men treated with radical prostatectomy from 1997 to 2009 at Kaiser Permanente Northwest, a large prepaid health plan in Portland, Oregon. Study subjects had aggressive prostate cancer with at least 1 of several criteria such as preoperative prostate specific antigen 20 ng/ml or greater, pathological Gleason score 8 or greater, stage pT3 disease or positive surgical margins at prostatectomy. The primary end point was clinical recurrence or metastasis after surgery evaluated using a time dependent c-index. Secondary end points were biochemical recurrence and salvage treatment failure. We compared the performance of Decipher alone to the widely used CAPRA-S (Cancer of the Prostate Risk Assessment Post-Surgical) score, and assessed the independent contributions of Decipher, CAPRA-S and their combination for the prediction of recurrence and treatment failure.
  
  
  
  Of the 224 patients treated 12 experienced clinical recurrence, 68 had biochemical recurrence and 34 experienced salvage treatment failure. At 10 years after prostatectomy the recurrence rate was 2.6% among patients with low Decipher scores but 13.6% among those with high Decipher scores (p=0.02). When CAPRA-S and Decipher scores were considered together, the discrimination accuracy of the ROC curve was increased by 0.11 compared to the CAPRA-S score alone (combined c-index 0.84 at 10 years after radical prostatectomy) for clinical recurrence.
  
  
  
  Decipher improves our ability to predict clinical recurrence in prostate cancer and adds precision to conventional pathological prognostic measures.
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Electronic address: Andrew.Glass@kpchr.org.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Glass
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Leo
authors.affiliation: GenomeDx Biosciences, Vancouver, British Columbia, Canada.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Haddad
authors.affiliation: GenomeDx Biosciences, Vancouver, British Columbia, Canada.
authors.forename: Kasra
authors.initials: K
authors.lastname: Yousefi
authors.affiliation: GenomeDx Biosciences, Vancouver, British Columbia, Canada.
authors.forename: Marguerite
authors.initials: M
authors.lastname: du Plessis
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Chuhe
authors.initials: C
authors.lastname: Chen
authors.affiliation: GenomeDx Biosciences, Vancouver, British Columbia, Canada.
authors.forename: Voleak
authors.initials: V
authors.lastname: Choeurng
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: San Diego Pathologists Medical Group, San Diego, California.
authors.forename: Bruce
authors.initials: B
authors.lastname: Robbins
authors.affiliation: San Diego Pathologists Medical Group, San Diego, California.
authors.forename: Seong
authors.initials: S
authors.lastname: Ra
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Richert-Boe
authors.affiliation: GenomeDx Biosciences, Vancouver, British Columbia, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Buerki
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Kathy
authors.initials: K
authors.lastname: Pearson
authors.affiliation: GenomeDx Biosciences, Vancouver, British Columbia, Canada.
authors.forename: Elai
authors.initials: E
authors.lastname: Davicioni
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Sheila
authors.initials: S
authors.lastname: Weinmann
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D003151:Community Health Centers; D023281:Genomics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000235:genetics* / Q000473:pathology; D009922:Oregon; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D016879:Salvage Therapy / Q000009:adverse effects; D017211:Treatment Failure
chemical_list: D014408:Biomarkers, Tumor
keywords: community health services; genomics; prognosis; prostatic neoplasms; recurrence