Use of genomic testing in localized prostate cancer can identify subsets of African American patients with aggressive disease.

Personalized genomic classifiers have transformed the management of prostate cancer by identifying the most aggressive subsets of prostate cancer. However, to date, the performance of genomic classifiers to risk-classify African American men has been lacking.

This study of the Decipher genomic classifier for National Cancer Center Network (NCCN) low-and intermediate-risk men matched non-African American men to African American men. The final analysis included a clinically balanced cohort of 226 patients with complete genomic information (113 African American men and 113 Non-African American men). A higher proportion of African American men with NCC-classified low-and favorable intermediate-risk prostate cancer had a higher Decipher score than Non-African American men. Self-identified African American men were twice more likely than Non-African American men to experience genomic risk of reclassification. In an ancestry-determined race model, a higher risk of reclassification in African American men was consistently validated. Race stratified analysis of genomic risk of reclassification vs non-genomic risk of reclassification tumors also revealed molecular differences in these tumor subtypes.

Integration of genomic classifiers with clinically-based risk classification can help identify the subset of African American men with localized prostate cancer who harbor high genomic risk of early metastatic disease. It is important to identify and appropriately risk-stratify the subset of African American men with aggressive disease who may benefit from more targeted interventions.

J of Nat’l. Cancer Inst. 2022 Sep