No AccessJournal of UrologyAdult Urology1 Dec 2013Validation of a Genomic Classifier that Predicts Metastasis Following Radical Prostatectomy in an At Risk Patient Population R. Jeffrey Karnes, Eric J. Bergstralh, Elai Davicioni, Mercedeh Ghadessi, Christine Buerki, Anirban P. Mitra, Anamaria Crisan, Nicholas Erho, Ismael A. Vergara, Lucia L. Lam, Rachel Carlson, Darby J.S. Thompson, Zaid Haddad, Benedikt Zimmermann, Thomas Sierocinski, Timothy J. Triche, Thomas Kollmeyer, Karla V. Ballman, Peter C. Black, George G. Klee, and Robert B. Jenkins R. Jeffrey KarnesR. Jeffrey Karnes Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Eric J. BergstralhEric J. Bergstralh Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota More articles by this author , Elai DavicioniElai Davicioni GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author , Mercedeh GhadessiMercedeh Ghadessi GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author , Christine BuerkiChristine Buerki GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author , Anirban P. MitraAnirban P. Mitra Department of Pathology, University of Southern California, Los Angeles, California More articles by this author , Anamaria CrisanAnamaria Crisan GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author , Nicholas ErhoNicholas Erho GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author , Ismael A. VergaraIsmael A. Vergara GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author , Lucia L. LamLucia L. Lam GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author , Rachel CarlsonRachel Carlson Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota More articles by this author , Darby J.S. ThompsonDarby J.S. Thompson EMMES Canada, Burnaby, British Columbia, Canada More articles by this author , Zaid HaddadZaid Haddad GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author , Benedikt ZimmermannBenedikt Zimmermann GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author , Thomas SierocinskiThomas Sierocinski GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author , Timothy J. TricheTimothy J. Triche GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Department of Pathology, University of Southern California, Los Angeles, California Current address: Center for Personalized Medicine, Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Department of Pathology and Pediatrics, Keck School of Medicine at University of Southern California, Los Angeles, California. More articles by this author , Thomas KollmeyerThomas Kollmeyer Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota More articles by this author , Karla V. BallmanKarla V. Ballman Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota Financial interest and/or other relationship with Journal of Clinical Oncology. More articles by this author , Peter C. BlackPeter C. Black Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author , George G. KleeGeorge G. Klee Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota More articles by this author , and Robert B. JenkinsRobert B. Jenkins Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.06.017AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Patients with locally advanced prostate cancer after radical prostatectomy are candidates for secondary therapy. However, this higher risk population is heterogeneous. Many cases do not metastasize even when conservatively managed. Given the limited specificity of pathological features to predict metastasis, newer risk prediction models are needed. We report a validation study of a genomic classifier that predicts metastasis after radical prostatectomy in a high risk population. Materials and Methods: A case-cohort design was used to sample 1,010 patients after radical prostatectomy at high risk for recurrence who were treated from 2000 to 2006. Patients had preoperative prostate specific antigen greater than 20 ng/ml, Gleason 8 or greater, pT3b or a Mayo Clinic nomogram score of 10 or greater. Patients with metastasis at diagnosis or any prior treatment for prostate cancer were excluded from analysis. A 20% random sampling created a subcohort that included all patients with metastasis. We generated 22-marker genomic classifier scores for 219 patients with available genomic data. ROC and decision curves, competing risk and weighted regression models were used to assess genomic classifier performance. Results: The genomic classifier AUC was 0.79 for predicting 5-year metastasis after radical prostatectomy. Decision curves showed that the genomic classifier net benefit exceeded that of clinical only models. The genomic classifier was the predominant predictor of metastasis on multivariable analysis. The cumulative incidence of metastasis 5 years after radical prostatectomy was 2.4%, 6.0% and 22.5% in patients with low (60%), intermediate (21%) and high (19%) genomic classifier scores, respectively (p <0.001). Conclusions: Results indicate that genomic information from the primary tumor can identify patients with adverse pathological features who are most at risk for metastasis and potentially lethal prostate cancer. References 1 : International variation in prostate cancer incidence and mortality rates. Eur Urol2012; 61: 1079. Google Scholar 2 : Prostate cancer epidemiology in the United States. World J Urol2012; 30: 195. Google Scholar 3 : Cancer statistics, 2012. CA Cancer J Clin2012; 62: 10. Google Scholar 4 : Prognostic factors for failure after prostatectomy. J Cancer2011; 2: 1. Google Scholar 5 : Impact of biochemical recurrence in prostate cancer among US veterans. Arch Intern Med2010; 170: 1390. 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Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byAtala A (2019) Re: Large-Scale Transcriptome-Wide Association Study Identifies New Prostate Cancer Risk RegionsJournal of Urology, VOL. 201, NO. 3, (447-447), Online publication date: 1-Mar-2019.Taneja S (2018) Re: Development and Validation of a Novel Integrated Clinical-Genomic Risk Group Classification for Localized Prostate CancerJournal of Urology, VOL. 200, NO. 3, (498-499), Online publication date: 1-Sep-2018.Taneja S (2018) Re: Development and Validation of a 24-Gene Predictor of Response to Postoperative Radiotherapy in Prostate Cancer: A Matched, Retrospective AnalysisJournal of Urology, VOL. 197, NO. 5, (1264-1266), Online publication date: 1-May-2017.Gild P and Abdollah F (2018) Editorial CommentJournal of Urology, VOL. 198, NO. 2, (361-361), Online publication date: 1-Aug-2017.Glass A, Leo M, Haddad Z, Yousefi K, du Plessis M, Chen C, Choeurng V, Abdollah F, Robbins B, Ra S, Richert-Boe K, Buerki C, Pearson K, Davicioni E and Weinmann S (2018) Validation of a Genomic Classifier for Predicting Post-Prostatectomy Recurrence in a Community Based Health Care SettingJournal of Urology, VOL. 195, NO. 6, (1748-1753), Online publication date: 1-Jun-2016.Taneja S (2018) Re: Impact of a Genomic Classifier of Metastatic Risk on Postprostatectomy Treatment Recommendations by Radiation Oncologists and UrologistsJournal of Urology, VOL. 195, NO. 5, (1472-1472), Online publication date: 1-May-2016.Johnson M, Ross A, Alshalalfa M, Erho N, Yousefi K, Glavaris S, Fedor H, Han M, Faraj S, Bezerra S, Netto G, Partin A, Trock B, Davicioni E and Schaeffer E (2018) SPINK1 Defines a Molecular Subtype of Prostate Cancer in Men with More Rapid Progression in an at Risk, Natural History Radical Prostatectomy CohortJournal of Urology, VOL. 196, NO. 5, (1436-1444), Online publication date: 1-Nov-2016. Volume 190Issue 6December 2013Page: 2047-2053Supplementary Materials Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsprostatic neoplasmsprostateneoplasm metastasisprognosistranscriptomeAcknowledgmentsStephanie Fink assisted with experiments.MetricsAuthor Information R. Jeffrey Karnes Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Eric J. Bergstralh Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota More articles by this author Elai Davicioni GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author Mercedeh Ghadessi GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author Christine Buerki GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author Anirban P. Mitra Department of Pathology, University of Southern California, Los Angeles, California More articles by this author Anamaria Crisan GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author Nicholas Erho GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author Ismael A. Vergara GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author Lucia L. Lam GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author Rachel Carlson Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota More articles by this author Darby J.S. Thompson EMMES Canada, Burnaby, British Columbia, Canada More articles by this author Zaid Haddad GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author Benedikt Zimmermann GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author Thomas Sierocinski GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author Timothy J. Triche GenomeDx Biosciences, Inc., Vancouver, British Columbia, Canada Department of Pathology, University of Southern California, Los Angeles, California Current address: Center for Personalized Medicine, Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Department of Pathology and Pediatrics, Keck School of Medicine at University of Southern California, Los Angeles, California. More articles by this author Thomas Kollmeyer Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota More articles by this author Karla V. Ballman Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota Financial interest and/or other relationship with Journal of Clinical Oncology. More articles by this author Peter C. Black Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada Financial interest and/or other relationship with GenomeDx Biosciences. More articles by this author George G. Klee Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota More articles by this author Robert B. Jenkins Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota More articles by this author Expand All Advertisement PDF downloadLoading ...