A RECENT study exploring the impact of multi-ancestry polygenic risk scores (PRS) on prostate cancer progression suggests these genetic tools may help refine active surveillance strategies for patients with low- to intermediate-risk prostate cancer. Conducted as part of the Canary Prostate Active Surveillance Study (PASS), the research involved 1,220 patients with clinically localized prostate cancer (PCa), monitored over a median of 5.3 years.
The study focused on the association between PRS—specifically, a score based on 451 PCa risk variants (PRS-451) and 400 variants excluding PSA-associated variants (PRS-400)—and tumor progression, measured by Gleason grade upgrading, prostate volume, and PSA density. The findings revealed that higher PRS scores were linked to a significantly increased risk of upgrading to a more aggressive cancer grade. A 1-standard deviation increase in PRS-451 was associated with a 23% higher hazard of upgrading, while PRS-400 showed a 27% increase.
Additionally, patients with higher PRS-400 had smaller prostate volumes, higher PSA density, and a greater percentage of biopsy cores positive for cancer, indicating a more aggressive disease phenotype. These associations suggest that polygenic risk scores could provide valuable insight into tumor behavior, potentially improving risk stratification and tailoring surveillance intensity.
While the study suggests that PRS may inform active surveillance decisions, further research is needed to confirm whether it can enhance clinical decision-making and reduce the burden of frequent healthcare visits for patients.
Helena Bradbury | AMJ
Reference
Goss LB et al. Polygenic Risk Score and Upgrading in Patients With Prostate Cancer Receiving Active Surveillance. JAMA Oncol. 2024. doi: 10.1001/jamaoncol.2024.5398.
