活检发现的前列腺癌的范围以及前列腺癌分级和基因组测试可以影响临床决策。这些因素对患有良性前列腺癌的男性的初始治疗方法和随后的患者结果的影响尚未在人群水平上确定。我们的目的是探讨 Decipher 22 基因基因组分类器 (GC) 活检测试与初次使用保守治疗与根治性前列腺切除术 (RP) 之间的关联，并确定 GC 评分对 RP 病理结果的独立影响。 总共 87 2016 年至 2018 年间，根据监测、流行病学和最终结果登记数据诊断出 140 名 1 级和 2 级前列腺癌患者，这些患者与 GC 检测结果相关联（2576 例接受了 GC 检测，84564 例未接受 GC 检测）。感兴趣的主要终点是接受保守治疗或 RP、病理升级（病理分级组 3-5）、分期（病理≥T3b）和不良病理特征（病理升级、分期或淋巴结侵犯）。多变量逻辑回归量化了变量与感兴趣结果的关联。GC 测试的患者更有可能在活检中获得 2 级（51% vs 46%，p < 0.001）和较低的前列腺特异性抗原（6.1 vs 6.3，p = 0.016）。 2016 年至 2018 年期间，GC 测试人群和未测试人群的保守治疗比例分别从 37% 增加到 39%，从 22% 增加到 24%。 GC 测试与保守治疗的几率增加显着相关（优势比 [OR] 2.1，95% 置信区间 [CI] 1.9-2.4，p < 0.001）。活检GC风险分布如下：45%低风险，30%中风险，25%高风险。在调整分析中，较高的 GC（每 0.1 增量）得分（OR 1.24，95% CI 1.17-1.31，p < 0.001）和阳性核心百分比（1.07，95% CI 1.02-1.12，p = 0.009）与收到RP。较高的 GC 评分与所有不良结果显着相关（病理升级 [OR 1.29，95% CI 1.12-1.49，p < 0.001]、升期 [OR 1.31，95% CI 1.05-1.62，p = 0.020] 和不良病理[OR 1.27，95% CI 1.12-1.45，p < 0.001]）。局限性包括与回顾性研究设计相关的观察偏差。接受 GC 检测的男性更有可能接受保守治疗。活检时的GC检测是基于大规模人群的登记中不良病理结果的预后。在这项对患有有利风险前列腺癌的男性的人群分析中，那些在活检时接受基因组检测的人更有可能接受保守治疗。在最初接受根治性前列腺切除术的男性中，较高的基因组风险与不良病理结果相关，但与肿瘤体积无关。在前列腺活检中使用基因组测试可以改善风险分层，并且比单独使用肿瘤体积可以更好地为治疗决策提供信息。版权所有 © 2024。由 Elsevier B.V. 出版。

The extent of prostate cancer found on biopsy, as well as prostate cancer grade and genomic tests, can affect clinical decision-making. The impact of these factors on the initial management approach and subsequent patient outcomes for men with favorable-grade prostate cancer has not yet been determined on a population level. Our objective was to explore the association of Decipher 22-gene genomic classifier (GC) biopsy testing on the initial use of conservative management versus radical prostatectomy (RP) and to determine the independent effect of GC scores on RP pathologic outcomes.A total of 87 140 patients diagnosed with grade group 1 and 2 prostate cancer between 2016 and 2018 from the Surveillance, Epidemiology, and End Results registry data were linked to GC testing results (2576 tested and 84 564 untested with a GC). The primary endpoints of interest were receipt of conservative management or RP, pathologic upgrading (pathologic grade group 3-5), upstaging (pathologic ≥T3b), and adverse pathologic features (pathologic upgrading, upstaging, or lymph node invasion). Multivariable logistic regressions quantified the association of variables with outcomes of interest.GC tested patients were more likely to have grade group 2 on biopsy (51% vs 46%, p < 0.001) and lower prostate-specific antigen (6.1 vs 6.3, p = 0.016). Conservative management increased from 37% to 39% and from 22% to 24% during 2016-2018 for the GC tested and untested populations, respectively. GC testing was significantly associated with increased odds of conservative management (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.9-2.4, p < 0.001). The distribution of biopsy GC risk was as follows: 45% low risk, 30% intermediate risk, and 25% high risk. In adjusted analyses, higher GC (per 0.1 increment) scores (OR 1.24, 95% CI 1.17-1.31, p < 0.001) and percent positive cores (1.07, 95% CI 1.02-1.12, p = 0.009) were significantly associated with the receipt of RP. A higher GC score was significantly associated with all adverse outcomes (pathologic upgrading [OR 1.29, 95% CI 1.12-1.49, p < 0.001], upstaging [OR 1.31, 95% CI 1.05-1.62, p = 0.020], and adverse pathology [OR 1.27, 95% CI 1.12-1.45, p < 0.001]). Limitations include observational biases associated with the retrospective study design.Men who underwent GC testing were more likely to undergo conservative management. GC testing at biopsy is prognostic of adverse pathologic outcomes in a large population-based registry.In this population analysis of men with favorable-risk prostate cancer, those who underwent genomic testing at biopsy were more likely to undergo conservative management. Of men who initially underwent radical prostatectomy, higher genomic risk but not tumor volume was associated with adverse pathologic outcomes. The use of genomic testing at prostate biopsy improves risk stratification and may better inform treatment decisions than the use of tumor volume alone.Copyright © 2024. Published by Elsevier B.V.