Walter Rayford, MD, PhD, MBA, a urologic oncologist with the Urology Group and associate professor of medicine at the University of Tennessee West Cancer Center, discusses the racial genomics of prostate cancer.

Prolaris is a commercially available cell-cycle progression tool that Rayford and his colleagues have used to stratify patients—particularly African-American patients&mdash;with newly diagnosed prostate cancer. By using this tool, physicians are better able to select patients who are eligible for active surveillance and those who need definitive treatment.

Another tool made available through GenomeDx looks at several genes expressed in prostate cancer. The grid accounts for over 40,000 genes. By using this tool in studies, Rayford and colleagues were able to identify which treatment strategy would be best suited for each patient. Collectively, these tools have led physicians to believe that although African-American and Caucasian patients have very similar clinical presentations, the mechanism of their prostate cancer can be very different, says Rayford.

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Dr. Rayford on the Racial Genomics of Prostate Cancer

Walter Rayford, MD, PhD, MBA, a urologic oncologist with the Urology Group and associate professor of medicine at the University of Tennessee West Cancer Center, discusses ways to improve stratification of patients with prostate cancer.

Rayford says that his research over the years has been geared toward identifying novel tools to safely place patients in different risk categories. In a study presented at the 2018 OncLive State of the Science Summit™ on Genitourinary Cancers, data suggested that there is a disparity in risk stratification between African American and Caucasian patients with prostate cancer.

Using a commercially available cell-cycle progression (CCP) score called Prolaris, researchers observed that 30% of African-American patients in the study who were initially deemed low-risk were actually at a more aggressive stage of disease. In the Caucasian cohort, 12% of low-risk patients were determined to be at a higher risk using the CCP tool.

Not only does this study help researchers further understand the mechanism of prostate cancer in the different racial groups, but it may eventually allow for a more personalized therapeutic approach. For example, if physicians can detect an aggressive disease early on, physicians can recommend more aggressive treatment much earlier, Rayford explains. He adds that while race-based studies are not yet standardized across the United States, high-impact cancer centers are starting to embrace their importance.

Dr. Rayford on Improving Stratification of Patients With Prostate Cancer

Walter Rayford, MD, PhD, MBA, a urologic oncologist with the Urology Group and associate professor of medicine at the University of Tennessee West Cancer Center, discusses a study aiming to refine racial risk stratification in prostate cancer.

The study used a commercially available cell cycle progression score called Prolaris to improve risk stratification in a community-based patient population. Tissue samples from 150 African-American and 60 Caucasian patients were taken from a single urologic oncology practice.

One of the key findings using this novel tool, Rayford says, was that 24% of African-American patients who were initially classified as normal-risk were actually at a higher risk in terms of disease volume and growth rate. It also re-stratified 50% of normal-risk Caucasian patients to a lower-risk group. Rayford adds that Prolaris also helps to re-stratify patients based on prostate-specific antigen, and Gleason, and Cancer of the Prostate Risk Assessment scores.

This is useful, Rayford concludes, because it better establishes which patients are eligible for active surveillance and which patients need more aggressive treatment as soon as possible.

Walter Rayford, MD, PhD, MBA

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Dr. Rayford on the Racial Genomics of Prostate Cancer

Dr. Rayford on Improving Stratification of Patients With Prostate Cancer

Dr. Rayford on Racial Risk Stratification in Prostate Cancer