基因组检测可以将风险分层信息添加到前列腺癌的临床病理学特征中，帮助临床医生和患者就主动监测（AS）或确定性治疗（DT）是否最合适做出共同的医疗决策。在这里，我们检查了诊断为局部中危前列腺癌的患者的初始 AS 选择和 3 年 AS 耐久性，这些患者在治疗决策前接受了 Prolaris 测试。这项回顾性观察队列研究包括来自 10 个研究中心的 3208 名患者，他们在诊断时接受了 Prolaris 测试从 2015 年 9 月到 2018 年 12 月。Prolaris 利用诊断活检时计算的组合临床细胞周期风险评分，根据 Prolaris AS 阈值（低于阈值，建议患者进行 AS 或高于阈值，建议患者进行 DT）对患者进行分层。通过 Prolaris 测试，比较推荐接受 AS 或 DT 的患者的 AS 选择率和 3 年 AS 耐久性。单变量和多变量 Logistic 回归模型以及 Cox 比例风险模型与分子和临床变量分别用作初始治疗决策和 AS 持久性的预测因子。 Prolaris 测试推荐的 AS 患者的 AS 选择率比推荐的 AS 患者高约 2 倍DT（p < 0.0001）。通过 Prolaris 测试推荐进行 AS 的患者的三年 AS 耐久性比推荐进行 DT 的患者高约 1.5 倍 (p< 0.0001)。在考虑 CAPRA 或格里森评分后，Prolaris 治疗推荐仍然是初始 AS 选择和 AS 持久性的统计显着预测因子。Prolaris 为临床风险分层添加了重要信息，以帮助制定治疗决策。与推荐 DT 的患者相比，Prolaris 推荐接受 AS 的中危前列腺癌患者最初更有可能继续接受 AS，并且更有可能在诊断后 3 年继续接受 AS。© 2024。作者。

Genomic testing can add risk stratification information to clinicopathological features in prostate cancer, aiding in shared medical decision-making between the clinician and patient regarding whether active surveillance (AS) or definitive treatment (DT) is most appropriate. Here we examined initial AS selection and 3-year AS durability in patients diagnosed with localized intermediate-risk prostate cancer who underwent Prolaris testing before treatment decision-making.This retrospective observational cohort study included 3208 patients from 10 study sites who underwent Prolaris testing at diagnosis from September 2015 to December 2018. Prolaris utilizes a combined clinical cell cycle risk score calculated at diagnostic biopsy to stratify patients by the Prolaris AS threshold (below threshold, patient recommended to AS or above threshold, patient recommended to DT). AS selection rates and 3-year AS durability were compared in patients recommended to AS or DT by Prolaris testing. Univariable and multivariable logistic regression models and Cox proportional hazard models were used with molecular and clinical variables as predictors of initial treatment decision and AS durability, respectively.AS selection was ~2 times higher in patients recommended to AS by Prolaris testing than in those recommended to DT (p < 0.0001). Three-year AS durability was ~1.5 times higher in patients recommended to AS by Prolaris testing than in those recommended to DT (p < 0.0001). Prolaris treatment recommendation remained a statistically significant predictor of initial AS selection and AS durability after accounting for CAPRA or Gleason scores.Prolaris added significant information to clinical risk stratification to aid in treatment decision making. Intermediate-risk prostate cancer patients who were recommended to AS by Prolaris were more likely to initially pursue AS and were more likely to remain on AS at 3 years post-diagnosis than patients recommended to DT.© 2024. The Author(s).