LAUSR

INTRODUCTION AND OBJECTIVE OncotypeDx Genomic Prostate Score (GPS) test is an RNA expression assay that can be performed on prostate biopsies. We sought to determine whether GPS was associated with increased risk of adverse pathology for men enrolled on active surveillance (AS) who later underwent RP. METHODS All AS patients at the University of California San Francisco (UCSF) were identified who had Gleason score (GS) 3+3 or low volume (≤33% positive cores) GS 3+4 PCa, GPS testing at diagnostic or confirmatory biopsy, clinical stage T1/T2, PSA <20, and clinical Cancer of the Prostate Risk Assessment (CAPRA) score <6. The primary outcome was adverse pathology, defined as GS ≥4+3, stage ≥pT3a or pN1. The secondary outcome was biochemical recurrence, defined as 2 consecutive PSA measurements >0.05 ng/mL following RP. RESULTS Of 215 men, 83% (N=179) were low risk, and 17% (N=36) were intermediate risk by CAPRA scoring. Median GPS was 26.4 (interquartile range [IQR]: 18.8, 34.6). In multivariate analysis, higher GPS was associated with increased risk of adverse pathology at delayed RP (Hazard Ratio [HR] per 5 units: 1.16, 95% Confidence Interval [CI]: 1.06, 1.26, p<.01). Higher GPS was also associated with increased risk of biochemical recurrence (HR per 5 units: 1.10; 95% CI: 1.00, 1.21, p=0.04). CONCLUSIONS In patients who undergo radical prostatectomy after a period on active surveillance, like those undergoing immediate prostatectomy, a higher GPS is associated with increased risk for adverse pathology. GPS is also associated with biochemical recurrence following RP in such patients.