DISCUSSION
Chicago‐based, death, tumor
TUMOR, METASTASIS, RECRUITMENT, SECONDARY, EVENTS, PATHOLOGY
Compared to previous retrospective studies, this study provides prospective level evidence through a randomized controlled trial to examine the clinical utility of genomic assays on provider treatment preference for PCa. Adding to its uniqueness, it also takes place in a safety net setting with a large percentage of Black men, who underutilize AS. Given the disparities that exist in rates of AS in Black men, and the inclusion of genomic testing into PCa treatment guidelines, it is important to understand how GPS testing might influence counseling by providers.In this study, we show how in this largely Black cohort, urologists' preference for prostatectomy/radiation almost doubled for patients who received GPS testing relative to patients who did not. In multivariable models, obtaining GPS testing was associated with an increased preference for prostatectomy/radiation, even after accounting for urologists' initial preference prior to genomic testing. Patients with favorable intermediate risk level and low health literacy were also significant predictors for urologists' preference for prostatectomy/radiation at Visit 2. Our prior publication showed that GPS also modestly increased patient's choice for prostatectomy/radiation, especially among men with low health literacy; it is possible that urologists' preferences drove that association.In the GPS arm subanalysis of GPS‐induced shifts in NCCN risk group, we found an interesting interaction between GPS scores and urologists' initial treatment preference. Using boxplots, we found that higher GPS scores seemed to shift urologists' preferences from AS to active treatment, but lower scores did not frequently shift preferences from active treatment back to AS. In fact, the GPS scores of men whose urologists initially preferred active treatment but changed to AS (Growing evidence highlights potential racial disparities that exist when recommending AS for PCa. For instance, a recent study of more than 51,000 veterans with low‐risk and intermediate‐risk PCa found that after adjusting for several clinical and demographic factors, Black veterans were less likely to receive AS.Within the last decade, genomic testing has gained popularity as an objective measure to assist patients and providers in treatment‐related decision‐making. The Oncotype DX GPS assay is a validated predictor of adverse pathology in both White and Black men.On the contrary, recruitment centers, such as those included in this study, are known for having high rates of high‐risk PCa.Although this was a secondary analysis from a randomized controlled trial, there are several limitations that should be noted. The number of urologists that participated in the study was limited given that we wanted counseling sessions to be as consistent as possible and increasing the pool size might have influenced the standardization of the protocol. The study was a multicentered trial conducted at three different Chicago‐based hospitals, yet all technically considered safety‐net hospitals, which serves a specific patient population. Forty percent of our patients harbored very low‐risk PCa, which might limit the generalizability of the results. Given the small number of events studied, we may have over‐fit the models given the wide 95% confidence intervals. Additionally, the GPS result format changed twice during the trial period, with the most recent version including 10‐year probabilities of death and metastasis. The majority of patients (76%) received the latest version, V3. Ten patients who were assigned to the GPS arm had insufficient tumor samples, so they were unable to process the test. An as‐treated analysis excluding these men in the cohort did not significantly change results from the study.