• TabrizAmir AlishahiAA0000-0002-6273-9105Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida (A.A.T.)., Matthew J Boyer, Adelaide M Gordon, David J Carpenter, Jeffrey R Gingrich, Sudha R Raman, Deepika Sirohi, Alexis Rompre-Brodeur, Joseph Lunyera, Fahmin Basher, Rhonda L Bitting, Andrzej S Kosinski, Sarah Cantrell, Belinda Ear, Jennifer M Gierisch, Morgan Jacobs, and Karen M Goldstein.
• Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida (A.A.T.).
• Ann. Intern. Med. 2025 Jan 21.

BackgroundTissue-based genomic classifiers (GCs) have been developed to improve prostate cancer (PCa) risk assessment and treatment recommendations.PurposeTo summarize the impact of the Decipher, Oncotype DX Genomic Prostate Score (GPS), and Prolaris GCs on risk stratification and patient-clinician decisions on treatment choice among patients with localized PCa considering first-line treatment.Data SourcesMEDLINE, EMBASE, and Web of Science published from January 2010 to August 2024.Study SelectionTwo investigators independently identified studies on risk classification and treatment choice after GC testing for patients with localized PCa considering first-line treatment.Data ExtractionRelevant data extracted by 1 researcher and overread by a second. Risk of bias (ROB) was assessed in duplicate.Data SynthesisTen studies reported risk reclassification after GC testing. In low ROB observational studies, very low- or low-risk patients with PCa were more likely to have their risk levels classified as the same or lower (GPS, 100% to 88.1%; Decipher, 87.2% to 82.9%; Prolaris, 76.9%). However, 1 randomized trial found that GC testing with GPS reclassified 34.5% of very low-risk and 29.4% of low-risk patients to a higher risk category. Twelve observational studies indicated that treatment decisions after GC testing either remained unchanged or slightly favored active surveillance. In contrast, analyses from a single randomized trial found fewer choices for active surveillance after GPS testing.LimitationsHeterogeneity in screening patterns, risk-determination cutoffs, pathology, and clinical practices. Studies on treatment choice were moderate to high ROB.ConclusionAlthough GC tests do not consistently influence risk classification or treatment decisions, the differences observed between observational and randomized studies highlight a need for well-designed trials to explore the role of GC tests in patients with newly diagnosed PCa considering first-line treatment.Primary Funding SourceU.S. Department of Veterans Affairs. (PROSPERO: CRD42022347950).

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