Jonathan David Tward ,MD, PHD, FASTRO – University of Utah
A study using the Prolaris test shows that it can accurately predict the personalized absolute benefit and number-needed-to-treat (NNT) for patients receiving androgen deprivation therapy (ADT) added to radiation therapy (RT) in newly diagnosed prostate cancer. By assessing the clinical cell-cycle risk (CCR) score, the study determined that patients with CCR scores above a prespecified multimodality treatment threshold (MTT) had a higher absolute benefit of ADT treatment (8.2% with NNT=12) compared to those below the MTT (0.86% with NNT=116). These findings provide valuable insights for personalized decision-making regarding the use of ADT in combination with RT for prostate cancer patients.
Jonathan Tward, MD, PhD, FASTRO, from U Health, University of Utah, conducted a study aiming to predict the absolute benefit of adding androgen deprivation therapy (ADT) to radiation therapy (RT) in patients with newly diagnosed prostate cancer.
The study utilized the Prolaris test, which combines the clinical cell-cycle risk (CCR) score and the cell cycle progression molecular score, to assess the aggressiveness of prostate cancer.
The researchers developed a model to estimate the 10-year risk of metastasis based on the continuous CCR score for patients treated with RT alone.
To determine the relative benefit of ADT added to RT, they analyzed data from The Meta-Analysis of Randomized trials in Cancer of the Prostate (MARCAP) which included several randomized trials involving RT with or without ADT.
A commercially tested cohort of 56,485 patients, spanning various risk categories, was used to calculate the average absolute benefit of ADT treatment.
Among the patients, 87.2% had CCR scores at or below a prespecified multimodality treatment threshold (MTT), while 12.7% had scores above the threshold.
For patients with CCR scores below the MTT, the average absolute benefit of ADT was 0.86% (NNT=116), indicating that 116 patients would need to be treated to prevent one from developing metastasis.
On the other hand, patients with CCR scores above the MTT had an average absolute benefit of 8.2% (NNT=12), suggesting a higher likelihood of preventing metastasis.
Patients with CCR scores precisely at the MTT had a predicted absolute benefit of 3.7% (NNT=27).
The study’s findings highlight the accuracy of the Prolaris Test in predicting the individual benefit of adding ADT to RT in prostate cancer treatment.
Furthermore, the identified risk threshold aligns with patient preferences regarding the inclusion or omission of ADT.
This information is crucial as patients and clinicians weigh the potential benefits and risks of treatment decisions.
Dr. Tward’s study contributes to personalized medicine in prostate cancer management by providing a tool to estimate the absolute benefit and number-needed-to-treat (NNT) for patients receiving ADT in addition to RT.
By utilizing the Prolaris test, clinicians can better inform patients about the potential benefits of combining therapies, allowing for more individualized treatment approaches and improved shared decision-making.
This research builds upon existing knowledge and may enhance clinical practice by aiding in treatment discussions and ultimately optimizing patient outcomes in the management of newly diagnosed prostate cancer.