BEDFORD, MA—Active surveillance (AS) has been widely implemented at the VA as a standard of care for low-risk prostate cancer (PCa). A study in the American Journal of Managed Care posits, however, that patient characteristics such as age, race and Agent Orange (AO) exposure may influence advisability of AS in veterans.1

A study team led by researchers from the Bedford, MA, VAMC also suggested that the 17-gene assay could improve risk stratification and management selection. Their objective was to compare management strategies for PCa at six VAMCs before and after introduction of the Oncotype DX Genomic ProstateScore (GPS) assay.

To do that, researchers reviewed records of patients diagnosed with PCa between 2013 and 2014 to identify management patterns in an untested cohort. From 2015 to 2016, these patients received GPS testing in a prospective study, and charts from six months post biopsy were analyzed for both cohorts to compare management received in the untested and tested cohorts. Included in the study were men who were newly-diagnosed with prostate cancers and have National Comprehensive Cancer Network (NCCN) very low-, low- and select cases of intermediate-risk PCa.

Results indicated that patient characteristics were generally similar in the untested and tested cohorts, although AS use was 12% higher in the tested cohort compared with the untested cohort. At the same time, in men younger than 60 years, utilization of AS in tested men was 33% higher than in untested men.

The study found that AS in tested men was higher across all NCCN risk groups and races, particular in low-risk men—72% vs. 90% for untested vs. tested, respectively. As for veterans exposed to AO, they were less likely to receive less AS than untested veterans, with tested nonexposed veterans receiving 19% more AS than untested veterans. Race or AO exposure was not found to have a significant effect on median GPS.

“Men who receive GPS testing are more likely to utilize AS within the year post diagnosis, regardless of age, race, and NCCN risk group,” the study authors wrote. “Median GPS was similar across racial groups and AO exposure groups, suggesting similar biology across these groups. The GPS assay may be a useful tool to refine risk assessment of PCa and increase rates of AS among clinically and biologically low-risk patients, which is in line with guideline-based care.”

1.    Lynch JA, Rothney MP, Salup RR, Ercole CE, et. al. Improving risk stratificationamong veterans diagnosed with prostate cancer: impact of the 17-gene prostatescore assay. Am J Manag Care. 2018 Jan;24(1 Suppl):S4-S10. PubMed PMID: 29337486.