{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:20:31Z","timestamp":1788430831036,"version":"build-2803163510"},"reference-count":33,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Urological Research Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tissue-based gene expression assays provide prognostic information in prostate cancer, but their influence on decisions regarding immediate treatment vs conservative management, including active surveillance (AS) and watchful waiting (WW), remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a linkage with the Surveillance, Epidemiology, and End Results program, we evaluated the association between a 22-gene genomic classifier (GC) and initial management among patients with low or intermediate clinical-risk prostate cancer diagnosed from 2015 through 2018. Initial management was classified as immediate therapy or AS\/WW, and GC scores were grouped as low (&amp;lt;0.45), intermediate (0.45-0.60), or high (&amp;gt;0.60). Multivariable logistic regression assessed associations between GC category and immediate treatment, stratified by clinical-risk group and adjusted for demographic and clinical covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2547 patients, 286 of 1030 (27.8%) with low clinical-risk prostate cancer and 1113 of 1517 (73.4%) with intermediate clinical-risk prostate cancer received initial treatment. Use of initial treatment increased with higher GC category. Among patients with low and intermediate clinical-risk prostate cancer, respectively, 20.5% and 57.5% with low GC, 28.3% and 75.8% with intermediate GC, and 46.2% and 88.3% with high GC scores received initial treatment. Higher GC category was independently associated with greater odds of immediate treatment vs AS\/WW (vs low GC: intermediate GC, odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.57 to 2.49, P\u2009&amp;lt;\u2009.001; high GC, OR = 4.42, 95% CI = 3.41 to 5.71, P\u2009&amp;lt;\u2009.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher GC scores were associated with greater use of immediate treatment and less use of AS\/WW, underscoring the need to determine whether GC testing also improves long-term outcomes among patients managed with AS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jnci\/djag247","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T14:19:59Z","timestamp":1788185999000},"source":"Crossref","is-referenced-by-count":0,"title":["Association between genomic classifier scores and initial management of localized prostate cancer in the United States"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0727-7614","authenticated-orcid":false,"given":"Michael S","family":"Leapman","sequence":"first","affiliation":[{"name":"Department of Urology, Yale School of Medicine , New Haven, CT,","place":["United States"]},{"name":"Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine , New Haven, CT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2169-4174","authenticated-orcid":false,"given":"Rong","family":"Wang","sequence":"additional","affiliation":[{"name":"Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine , New Haven, CT,","place":["United States"]},{"name":"Department of Chronic Disease Epidemiology, Yale School of Public Health , New Haven, CT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preston C","family":"Sprenkle","sequence":"additional","affiliation":[{"name":"Department of Urology, Yale School of Medicine , New Haven, CT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac Y","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Urology, Yale School of Medicine , New Haven, CT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3933-9207","authenticated-orcid":false,"given":"Stacy","family":"Loeb","sequence":"additional","affiliation":[{"name":"Department of Urology, New York University Langone Health , New York, NY,","place":["United States"]},{"name":"Department of Population Health, New York University Langone Health , New York, NY,","place":["United States"]},{"name":"Manhattan Veterans Affairs Medical Center , New York, NY,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4089-7399","authenticated-orcid":false,"given":"Tyler M","family":"Seibert","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences, University of California San Diego , La Jolla, CA,","place":["United States"]},{"name":"Department of Radiology, University of California San Diego , La Jolla, CA,","place":["United States"]},{"name":"Department of Bioengineering, University of California San Diego , La Jolla, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4339-6685","authenticated-orcid":false,"given":"Matthew R","family":"Cooperberg","sequence":"additional","affiliation":[{"name":"Department of Urology, University of California San Francisco , San Francisco, CA,","place":["United States"]},{"name":"Department of Epidemiology and Biostatistics, University of California San Francisco , San Francisco, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter H","family":"Gann","sequence":"additional","affiliation":[{"name":"Department of Pathology, College of Medicine, University of Illinois at Chicago , Chicago, IL,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Ginsburg","sequence":"additional","affiliation":[{"name":"Department of Urology, Wayne State University , Detroit, MI,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J","family":"Catalona","sequence":"additional","affiliation":[{"name":"Department of Urology, Northwestern University Feinberg School of Medicine , Chicago, IL,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela A","family":"Dinan","sequence":"additional","affiliation":[{"name":"Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine , New Haven, CT,","place":["United States"]},{"name":"Department of Chronic Disease Epidemiology, Yale School of Public Health , New Haven, CT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cary P","family":"Gross","sequence":"additional","affiliation":[{"name":"Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine , New Haven, CT,","place":["United States"]},{"name":"Department of Internal Medicine, Yale School of Medicine , New Haven, CT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9472-8032","authenticated-orcid":false,"given":"Xiaomei","family":"Ma","sequence":"additional","affiliation":[{"name":"Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine , New Haven, CT,","place":["United States"]},{"name":"Department of Chronic Disease Epidemiology, Yale School of Public Health , New Haven, CT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"2026090306015615600_djag247-B1","author":"National Comprehensive Cancer N. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae): Prostate Cancer","year":"2026"},{"key":"2026090306015615600_djag247-B2","doi-asserted-by":"publisher","first-page":"2033","DOI":"10.1001\/jama.2024.20580","article-title":"Active surveillance or watchful waiting for intermediate-risk prostate cancer, 2010-2020","volume":"332","author":"Ajjawi","year":"2024","journal-title":"JAMA"},{"key":"2026090306015615600_djag247-B3","doi-asserted-by":"publisher","first-page":"e35968","DOI":"10.1002\/cncr.35968","article-title":"Identifying cribriform and intraductal histology on magnetic resonance imaging-assisted biopsy for patients with intermediate-grade prostate cancer: implications for active surveillance","volume":"131","author":"Grant","year":"2025","journal-title":"Cancer"},{"key":"2026090306015615600_djag247-B4","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1056\/NEJMoa2214122","article-title":"Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer","volume":"388","author":"Hamdy","year":"2023","journal-title":"N Engl J Med"},{"key":"2026090306015615600_djag247-B5","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1001\/jamaoncol.2020.6086","article-title":"Regional adoption of commercial gene expression testing for prostate cancer","volume":"7","author":"Leapman","year":"2021","journal-title":"JAMA Oncol"},{"key":"2026090306015615600_djag247-B6","doi-asserted-by":"publisher","first-page":"e2128646","DOI":"10.1001\/jamanetworkopen.2021.28646","article-title":"Adoption of new risk stratification technologies within US hospital referral regions and association with prostate cancer management","volume":"4","author":"Leapman","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026090306015615600_djag247-B7","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.eururo.2020.11.021","article-title":"A systematic review of the evidence for the decipher genomic classifier in prostate cancer","volume":"79","author":"Jairath","year":"2021","journal-title":"Eur Urol"},{"key":"2026090306015615600_djag247-B8","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.eururo.2024.09.011","article-title":"Impact of gene expression classifier testing on adjuvant treatment following radical prostatectomy: the G-MINOR prospective randomized cluster-crossover trial","volume":"87","author":"Morgan","year":"2025","journal-title":"Eur Urol"},{"key":"2026090306015615600_djag247-B9","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1016\/j.euf.2022.08.001","article-title":"Trials in the key of G: building level 1 evidence on the real-world effectiveness of prostate biomarkers","volume":"8","author":"Okoth","year":"2022","journal-title":"Eur Urol Focus"},{"key":"2026090306015615600_djag247-B10","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1093\/jncimonographs\/lgae013","article-title":"Reporting tumor genomic test results to SEER registries via linkages","volume":"2024","author":"Petkov","year":"2024","journal-title":"JNCI Monographs"},{"key":"2026090306015615600_djag247-B11","doi-asserted-by":"publisher","first-page":"1504","DOI":"10.1016\/j.euo.2024.06.007","article-title":"Use of decipher prostate biopsy test in patients with favorable-risk disease undergoing conservative management or radical prostatectomy in the surveillance, epidemiology, and end results registry","volume":"7","author":"Zhu","year":"2024","journal-title":"Eur Urol Oncol"},{"key":"2026090306015615600_djag247-B12","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkad052","article-title":"Use of the Decipher genomic classifier among men with prostate cancer in the United States","volume":"7","author":"Zaorsky","year":"2023","journal-title":"JNCI Cancer Spectr"},{"key":"2026090306015615600_djag247-B13","year":"2025"},{"key":"2026090306015615600_djag247-B14","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1001\/jamaoncol.2020.7671","article-title":"Validation of a 22-gene genomic classifier in patients with recurrent prostate cancer: an ancillary study of the NRG\/RTOG 9601 randomized clinical trial","volume":"7","author":"Feng","year":"2021","journal-title":"JAMA Oncol"},{"key":"2026090306015615600_djag247-B15","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1001\/jama.280.11.969","article-title":"Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer","volume":"280","author":"D\u2019Amico","year":"1998","journal-title":"JAMA"},{"key":"2026090306015615600_djag247-B16","doi-asserted-by":"publisher","first-page":"EVIDoa2300018","DOI":"10.1056\/EVIDoa2300018","article-title":"Patient-reported outcomes 12 years after localized prostate cancer treatment","volume":"2","author":"Donovan Jenny","year":"2023","journal-title":"NEJM Evid"},{"key":"2026090306015615600_djag247-B17","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1002\/bco2.277","article-title":"Patient experiences with tissue-based genomic testing during active surveillance for prostate cancer","volume":"5","author":"Leapman","year":"2024","journal-title":"BJUI Compass"},{"key":"2026090306015615600_djag247-B18","doi-asserted-by":"publisher","first-page":"1660","DOI":"10.1200\/jco.20.02997","article-title":"Impact of a genomic test on treatment decision in a predominantly African American population with favorable-risk prostate cancer: a randomized trial","volume":"39","author":"Murphy","year":"2021","journal-title":"JCO"},{"key":"2026090306015615600_djag247-B19","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1097\/upj.0000000000000679","article-title":"Associations between prostate magnetic resonance imaging, genomic testing, and treatment for localized prostate cancer","volume":"11","author":"Sundaresan","year":"2024","journal-title":"Urol Pract"},{"key":"2026090306015615600_djag247-B20","doi-asserted-by":"publisher","first-page":"19690","DOI":"10.1002\/cam4.6615","article-title":"Impact of genomic testing on urologists\u2019 treatment preference in favorable risk prostate cancer: a randomized trial","volume":"12","author":"Carbunaru","year":"2023","journal-title":"Cancer Med"},{"key":"2026090306015615600_djag247-B21","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.euo.2023.01.003","article-title":"Best current practice and research priorities in active surveillance for prostate cancer-a report of a Movember International Consensus Meeting","volume":"6","author":"Moore","year":"2023","journal-title":"Eur Urol Oncol"},{"key":"2026090306015615600_djag247-B22","doi-asserted-by":"publisher","first-page":"2084","DOI":"10.1001\/jama.2024.6695","article-title":"Long-term outcomes in patients using protocol-directed active surveillance for prostate cancer","volume":"331","author":"Newcomb","year":"2024","journal-title":"JAMA"},{"key":"2026090306015615600_djag247-B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.euo.2025.06.012","article-title":"Predicting active surveillance failure for patients with prostate cancer in the magnetic resonance imaging era: a multicentre transatlantic cohort study","author":"Sushentsev","year":"2025","journal-title":"Eur Urol Oncol"},{"key":"2026090306015615600_djag247-B24","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.euros.2025.06.012","article-title":"External validation of the international staging collaboration for cancer of the prostate (STAR-CAP) prognostic system in patients managed with active surveillance","volume":"79","author":"Berlin","year":"2025","journal-title":"Eur Urol Open Sci"},{"key":"2026090306015615600_djag247-B25","doi-asserted-by":"publisher","first-page":"e203187","DOI":"10.1001\/jamaoncol.2020.3187","article-title":"Tailoring intensity of active surveillance for low-risk prostate cancer based on individualized prediction of risk stability","volume":"6","author":"Cooperberg","year":"2020","journal-title":"JAMA Oncol"},{"key":"2026090306015615600_djag247-B26","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1111\/his.15231","article-title":"Proposal for an optimised definition of adverse pathology (unfavourable histology) that predicts metastatic risk in prostatic adenocarcinoma independent of grade group and pathological stage","volume":"85","author":"Nguyen","year":"2024","journal-title":"Histopathology"},{"key":"2026090306015615600_djag247-B27","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1001\/jamainternmed.2022.7100","article-title":"Use of active surveillance vs definitive treatment among men with low- and favorable intermediate\u2013risk prostate cancer in the US between 2010 and 2018","volume":"183","author":"Al Hussein Al Awamlh","year":"2023","journal-title":"JAMA Intern Med"},{"key":"2026090306015615600_djag247-B28","doi-asserted-by":"publisher","first-page":"e2417274","DOI":"10.1001\/jamanetworkopen.2024.17274","article-title":"Development of a longitudinal prostate cancer transcriptomic and clinical data linkage","volume":"7","author":"Leapman","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026090306015615600_djag247-B29","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1016\/j.euo.2024.07.010","article-title":"Association between the decipher genomic classifier and prostate cancer outcome in the real-world setting","volume":"8","author":"Leapman","year":"2025","journal-title":"Eur Urol Oncol"},{"key":"2026090306015615600_djag247-B30","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1111\/his.70036","article-title":"Correlation of unfavourable and favourable histology at radical prostatectomy with Decipher scores and freedom from biochemical recurrence","volume":"88","author":"Greenland","year":"2026","journal-title":"Histopathology"},{"key":"2026090306015615600_djag247-B31","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.urology.2025.12.004","article-title":"Sociodemographic factors associated with tissue-based genomic testing for prostate cancer","volume":"210","author":"Diaz","year":"2026","journal-title":"Urology"},{"key":"2026090306015615600_djag247-B32","doi-asserted-by":"publisher","first-page":"e2031349","DOI":"10.1001\/jamanetworkopen.2020.31349","article-title":"Regional variation in active surveillance for low-risk prostate cancer in the US","volume":"3","author":"Washington","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2026090306015615600_djag247-B33","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1097\/ju.00000000000031590","article-title":"Use of monitoring tests among patients with localized prostate cancer managed with observation","volume":"209","author":"Leapman","year":"2023","journal-title":"J Urol"}],"container-title":["JNCI: Journal of the National Cancer Institute"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jnci\/advance-article-pdf\/doi\/10.1093\/jnci\/djag247\/70883184\/djag247.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jnci\/advance-article-pdf\/doi\/10.1093\/jnci\/djag247\/70883184\/djag247.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:03:13Z","timestamp":1788429793000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jnci\/advance-article\/doi\/10.1093\/jnci\/djag247\/8776805"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":33,"URL":"https:\/\/doi.org\/10.1093\/jnci\/djag247","relation":{},"ISSN":["0027-8874","1460-2105"],"issn-type":[{"value":"0027-8874","type":"print"},{"value":"1460-2105","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"article-number":"djag247"}}