2056 - Examining Potential Barriers to Obtaining Decipher Scores in Prostate Adenocarcinoma Considered for Radiation

A. J. Hsu^1,2, G. K. Harada¹, J. Yeakel¹, E. M. Uchio³, D. I. Lee³, M. Daneshvar³, G. E. Gin³, A. Rezazadeh⁴, N. Mar⁴, and S. N. Seyedin¹; ¹Department of Radiation Oncology, University of California - Irvine, Orange, CA, ²California University of Science and Medicine, Colton, CA, ³Department of Urology, UC Irvine School of Medicine, Orange, CA, ⁴Division of Hematology/Oncology, Department of Medicine, UC Irvine School Of Medicine, Orange, CA

Purpose/Objective(s): The NCCN has recently incorporated various genomic classifiers and risk stratifiers such as Decipher for more personalized treatment of prostate cancer. However, not all prostate cancer biopsies will undergo further classification. The aim of this study was to examine patient and socioeconomic barriers toward obtaining a Decipher score in patients who were considered for definitive radiation. Materials/

Methods: This single-institution study included prostate cancer patients evaluated for definitive radiation from 2016-2023 when Decipher was routinely obtained at this institution. The primary endpoint was whether patients’ biopsy underwent Decipher classification or not. We extracted variables from the electronic health record, including median household income determined by zip code, distance from the institution, age, primary language, marital status, insurance category, and race. Insurance was divided into four categories: non-managed Medicare, Medicaid, HMO, and PPO. We examined the correlation between ordering Decipher scores and the variables using Fisher versus chi-square for categorical data and Wilcoxon rank sum versus two-sided t-test for continuous data. The threshold of statistical significance was set to p<0.05.
Results: At the time of analysis, 196 patients met inclusion criteria. 106 patients (58.9%) had Decipher scores ordered. 9 patients had node or metastasis-positive disease. The majority of patients had clinical T stage of T1c (59.2%) and T3b (14.8%), Gleason score of 3+4 (28.5%) and 4+3 (23.8%), and Grade Group of 2 (28.5%) and 3 (23.83%). 110 patients (59.8%) had high-risk or very high-risk prostate cancer. On analysis, patients who obtained a Decipher score had a higher median income by zip code than those who did not (median = $104,971 IQR = $80,266-121,275 vs. median = $92,765 IQR= $74,002-112,118, p = 0.038). There were no differences between all other variables. Using a Poisson regression model, the incidence rate ratio of obtaining a Decipher was found to increase 18% per year across the study interval. This positive trend was still present when constrained to the COVID-19 pandemic.
Conclusion: While this study noted an annual increase in obtaining Decipher assays, differences existed in median household income between patients who obtained Decipher scores and those who did not. This suggests financial bias affects whether physicians offer or patients choose to obtain a Decipher score. This could lead to overtreatment and higher toxicity rates in lower-income patients and warrants further investigation.