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Sociodemographic Features, Health Care Costs, and Treatment Implications of Genomic Classifier Testing for Localized Prostate Cancer in the United States
Journal article   Peer reviewed

Sociodemographic Features, Health Care Costs, and Treatment Implications of Genomic Classifier Testing for Localized Prostate Cancer in the United States

James R Janopaul-Naylor, Dattatraya Patil, Shreyas Joshi, Martin G Sanda, Nikhil Sebastian, Kamran Salari, Jade Dodge, Vishal R Dhere, Bruce W Hershatter, Pretesh R Patel, …
JCO precision oncology, v 9(9), e2500406
Aug 2025
DOI: https://doi.org/10.1200/PO-25-00406
PMID: 40834325
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Ablation Techniques - economics Ablation Techniques - methods Adult Androgen Antagonists - therapeutic use Biopsy Chemoradiotherapy - economics Chemoradiotherapy - methods Genomics - economics Genomics - statistics & numerical data Health Care Costs Humans Insurance, Health - economics Insurance, Health - statistics & numerical data Male Medicare - economics Medicare - statistics & numerical data Middle Aged Molecular Diagnostic Techniques - economics Molecular Diagnostic Techniques - statistics & numerical data Patient Acceptance of Health Care - statistics & numerical data Patient Selection Prostate - pathology Prostate - surgery Prostatectomy - economics Prostatectomy - methods Prostatic Neoplasms - economics Prostatic Neoplasms - genetics Prostatic Neoplasms - pathology Prostatic Neoplasms - therapy Sociodemographic Factors Watchful Waiting - economics Watchful Waiting - statistics & numerical data Young Adult United States
Biopsy tissue-based genomic classifiers (GCs) for prostate cancer are commercially available tools to enhance prognostication. They may corroborate candidacy for active surveillance/watchful waiting (AS/WW) or identify men who are more likely to benefit from radiotherapy (RT) with androgen deprivation therapy (ADT). We analyze real-world use of GC and associations with clinical decision making. We examined US commercial (n = 134,561) and Medicare (n = 68,431) insurance claims of men with newly diagnosed, localized prostate cancer between 2013 and 2022. We evaluated utilization of GCs over time and compared use of AS/WW, RT with or without ADT, radical prostatectomy (RP), or focal ablative therapy (FT) based on the receipt and type of GC. GC utilization increased from <1% to 17% in 8 years with a median payment of $3,001 (IQR, $0-3,873). Younger age, higher median household income, and high-deductible health insurance were associated with higher odds of receiving a GC (all < .001). Patients with GC were more likely to pursue AS/WW than treatment (odds ratio, 2.00 [95% CI, 1.85 to 2.1]; < .001). Patients receiving OncotypeDX, Prolaris, and Decipher were most likely to pursue AS/WW, RP, and RT with ADT, respectively (all < .001). Prolaris was ordered more than three times as often in Detroit as in any other city, whereas OncotypeDx was ordered more than twice as often in New York City as in any other city. We show contemporary, real-world GC utilization trends, costs, and associations with treatment patterns. Prospective trials are ongoing to validate GC-informed treatment, but US uptake has expanded and management is associated with the use and type of GC.

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Collaboration types
Domestic collaboration
Web of Science research areas
Oncology
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