1. Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO-IMPACT study
- Author
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John L, Gore, Marguerite, du Plessis, María, Santiago-Jiménez, Kasra, Yousefi, Darby J S, Thompson, Lawrence, Karsh, Brian R, Lane, Michael, Franks, David Y T, Chen, Mark, Bandyk, Fernando J, Bianco, Gordon, Brown, William, Clark, Adam S, Kibel, Hyung L, Kim, William, Lowrance, Murugesan, Manoharan, Paul, Maroni, Scott, Perrapato, Paul, Sieber, Edouard J, Trabulsi, Robert, Waterhouse, Elai, Davicioni, Yair, Lotan, and Daniel W, Lin
- Subjects
Male ,Decision Making ,Anxiety ,Risk Assessment ,Conflict, Psychological ,Surveys and Questionnaires ,Humans ,Prospective Studies ,Neoplasm Metastasis ,salvage therapy ,Aged ,Prostatectomy ,Prostatic Neoplasms ,adjuvant therapy ,Original Articles ,Middle Aged ,prostate cancer ,decisional conflict ,Logistic Models ,quality of life ,Multivariate Analysis ,Decipher ,Radiotherapy, Adjuvant ,Original Article ,Genitourinary Disease ,Disease Site - Abstract
BACKGROUND Patients with prostate cancer and their providers face uncertainty as they consider adjuvant radiotherapy (ART) or salvage radiotherapy (SRT) after undergoing radical prostatectomy. The authors prospectively evaluated the impact of the Decipher test, which predicts metastasis risk after radical prostatectomy, on decision making for ART and SRT. METHODS A total of 150 patients who were considering ART and 115 who were considering SRT were enrolled. Providers submitted a management recommendation before processing the Decipher test and again at the time of receipt of the test results. Patients completed validated surveys on prostate cancer (PCa)‐specific decisional effectiveness and PCa‐related anxiety. RESULTS Before the Decipher test, observation was recommended for 89% of patients considering ART and 58% of patients considering SRT. After Decipher testing, 18% (95% confidence interval [95% CI], 12%‐25%) of treatment recommendations changed in the ART arm, including 31% among high‐risk patients; and 32% (95% CI, 24%‐42%) of management recommendations changed in the salvage arm, including 56% among high‐risk patients. Decisional Conflict Scale (DCS) scores were better after viewing Decipher test results (ART arm: median DCS before Decipher, 25 and after Decipher, 19 [P, Use of the Decipher test appears to result in a change in treatment decision making in a substantial percentage of men with prostate cancer who are considering adjuvant or salvage radiotherapy after radical prostatectomy. Decisional effectiveness improves for both patients and providers with use of the Decipher test.
- Published
- 2016