DECIPHER® GENOMIC CLASSIFIER ON INITIAL PROSTATE BIOPSY IS ASSOCIATED WITH GLEASON SCORE UPGRADING ON FINAL RADICAL PROSTATECTOMY PATHOLOY.

Traditionally, prostate-specific antigen (PSA) has been used to screen for prostate cancer (PCa). However, the utility of PSA has become controversial due to poor diagnostic accuracy. Other clinical tools such as prostate multiparametric MRI (mpMRI) and genomic classifiers like Decipher® genomic classifier (GC) are recommended to risk stratify newly diagnosed prostate cancer (PCa) patients in the pre-treatment setting.While mpMRI, interpreted with Prostate Imaging-Reporting and Data System (PI-RADS), is considered predictive of prostatectomy pathology, Decipher® GC has been shown to independently predict adverse pathology in patients with PCa.;;Our aim for this study was to examine the relationship between pre-treatment Decipher ® and mpMRI on prostatectomy pathology. We retrospectively examined patients at our institution who underwent Decipher® GC testing on prostate biopsy tissue (n=888) between December 2016 and March 2023. Data regarding PSA, MRI PIRADS score, biopsy Gleason grade group (GGG), Decipher® GC score and treatment modality were collected.; Of these patients, 142 underwent prostatectomy, of which 118 patients had GGG 1-3 on biopsy.We performed a multivariable ordinal logistic regression model with prostatectomy GGG upgrading (e.g., GGG increase from biopsy) as the outcome and PSA, biopsy GGG, Decipher and PIRADS score as potential predictors. Our final cohort included 104 patients who had an mpMRI, GGG 1-3 on biopsy, and Decipher® GC prior to prostatectomy (Table 1). We found that Decipher® GC on biopsy was associated upgrading on prostatectomy GGG (p = 0.043). There was no significant association with PIRADS score (p = 0.196), PSA (p = 0.217) or biopsy GGG2 compared to GGG1 (p = 0.345). As expected, there is a strong association with prostatectomy GGG upgrading with biopsy GGG3 (p = 0.003) (Table 2). Tumor based molecular assays such as Decipher® GC are included in the NCCN guidelines for localized prostate cancer management. Decipher® GC has been shown to independently predict adverse pathology in patients with very low-, low- and intermediate-risk PCa.; We found that Decipher® GCand unfavorable intermediate risk biopsy are predictors of upgrading on prostatectomy, while mpMRI (PIRADS) and PSA are not. [ABSTRACT FROM AUTHOR]