Guidelines Update Supports Use of Genomic Tests in Early Prostate Cancer Management

A new update to guidelines from the American Urological Association for the management of patients with localized early-stage prostate cancer has endorsed selective use of genomic biomarker tests.

The AUA’s 2022 update now states that clinicians may use tissue-based genomic biomarkers when added risk-stratification could alter their clinical decision-making. However, the guidelines do not endorse routine use of these tests, citing a lack of validation evidence that meets a high enough bar.

Despite the cautious take, test-makers greeted the new recommendations as positive.

The guidelines said available commercial tests, including Oncotype Dx, Myriad Genetics’ Prolaris, and Veracyte’s Decipher, can predict adverse pathology as well as the risks of biochemical recurrence, metastasis, and prostate cancer death.

Based on the level of existing data, the guidelines panel decided to recommend against routine use but allow for clinicians to elect to use tests when added risk stratification may alter their course of treatment.

Cited examples include patients with high-volume Gleason score 6 cancer and some patients with intermediate-risk cancer who are interested in active surveillance.