A groundbreaking study from the Moffitt Cancer Center sheds light on a crucial aspect of prostate cancer treatment: the identification of high-risk patients. This research highlights how a genomic test, widely used in clinical settings, can more accurately pinpoint early-stage prostate cancer patients who are likely to experience a quick return of their disease. Notably, the findings emphasize the impact this can have on African American men, who are disproportionately affected by prostate cancer.
Prostate cancer holds the grim distinction of being the second most diagnosed cancer among men globally and stands as a leading cause of cancer-related deaths in the U.S. The statistics are particularly troubling for African American men, who face a 73% higher incidence and a 23% greater mortality rate compared to their white counterparts. Historically, this demographic has been underrepresented in genomic studies, which play a vital role in shaping evidence-based treatment guidelines.
Inside the VANDAAM Study
The VANDAAM study, a pivotal investigation, recruited 243 men with early-stage prostate cancer receiving treatment at Moffitt and affiliated hospitals from 2016 to 2021. Among these participants, African American and white men were represented equally and diagnosed with comparable risk levels. Before treatment commenced, all participants underwent the Decipher genomic test, analyzing their biopsy tissue. A follow-up of approximately two years was conducted to monitor for early signs of recurrence.
The focal point of the analysis included 207 men who completed the required testing and follow-up, split nearly evenly between African American (104) and white (103) men. Treatment varied, encompassing either surgical intervention or definitive radiotherapy, guided by established standard-of-care protocols. Regular PSA blood tests served to track potential rises, indicating cancer recurrence.
Key Findings on Early Recurrence Risk
A striking revelation emerged from the study: men with a high genomic risk score were five times more likely to experience a rise in their PSA levels within two years compared to those with low-risk scores. This analysis remained robust even after accounting for age, PSA levels, Gleason score, and other related clinical factors. For African American participants, this correlation was even more pronounced—those scoring high on the genomic test had approximately 17 times the odds of early recurrence, with every African American man who did experience a recurrence falling into this high-risk category.
The integration of genomic risk scores with standard clinical data allowed researchers to effectively distinguish between African American men whose cancers recurred within two years and those who remained free of recurrence. Interestingly, the risk-linkage exhibited consistency across racial lines, holding true for both groups and treatment modalities.
“One of the most important messages from this study is that genomic risk information adds useful detail on top of the tools clinicians already use,” said Dr. Kosj Yamoah, the study’s principal investigator and chair of the Radiation Oncology Department at Moffitt. “For African American men with early prostate cancer, this test helped separate a small group with rapid recurrence from the large group who remained cancer-free at two years.”
Implications for Treatment Decisions and Equity
The implications of this study are significant. Remarkably, in about 75% of the men who had genomic tests performed on both their biopsy and the prostate tissue removed during surgery, the risk categorization remained consistent. This finding suggests that conducting the genomic test on biopsy material alone can often provide reliable direction for treatment decisions. Cancers identified as having a higher genomic risk post-surgery tended to show upgrades in the front sections of the prostate, indicating that routine biopsies might not capture the full picture.
Additionally, a smaller subset of tumors in African American participants displayed a unique genomic profile characterized by high immune activity and decreased DNA repair signals. This distinction could clarify why some African American patients respond particularly well to radiotherapy, as highlighted in this study and others.
“These data support using genomic testing earlier in care to better match African American patients with the treatment intensity and type that fit the biology of their tumor,” Dr. Yamoah emphasized. “It is one practical step toward narrowing long-standing differences in prostate cancer outcomes.”
Next Steps and Need for Larger Cohorts
Despite the valuable insights gained, researchers acknowledged that the study’s scope was limited, with only 15 participants experiencing recurrence within the two-year follow-up. The need for larger, more diverse studies is paramount to refine these risk estimates and monitor long-term outcomes, such as cancer spread and survival rates. The investigators advocate for the inclusion of Decipher genomic testing in routine risk assessments, enabling healthcare providers to identify African American men with localized prostate cancer who may require more vigilant follow-up or intensified treatments.