2018/3/27 Genetic risk score Stratification of Susceptibility Each snP has modest effect size Cancer Genetic risk score(RGS) Based on multiple disease risk-associated SNPs, and weighted by their effect. New PSA Guidelines Discourage Stratification of Susceptibility Genetic risk score: based on risk-associated genotype Prostate Cancer Prevention Trial(PCPD Nearly 90% of men with PSA-detected prostate cancer undergo early treatment y Precision Prediction Aiding the prognosis that help to establish anagement strategy.2018/3/27 8  Each SNP has modest effect size  Multiple SNPs confer a stronger effect to disease Genetic risk score (RGS)  Based on multiple disease risk-associated SNPs, and weighted by their effect. Genetic risk score All Family history 24% 29% 23% 18% 24% 33% 36% 0% 10% 20% 30% 40% All (N=4,528) FH+ (17%) FH- (83%) <0.6 (25%) 0.6-1.4 (54%) >1.4 (21%) >2.0 (8%) Detec on rate 24% 29% 23% 18% 24% 33% 36% 0% 10% 20% 30% 40% All (N=4,528) FH+ (17%) FH- (83%) <0.6 (25%) 0.6-1.4 (54%) >1.4 (21%) >2.0 (8%) Detec on rate Prostate Cancer Prevention Trial (PCPT) Stratification of Susceptibility All Family history 24% 29% 23% 18% 24% 33% 36% 0% 10% 20% 30% 40% All (N=4,528) FH+ (17%) FH- (83%) <0.6 (25%) 0.6-1.4 (54%) >1.4 (21%) >2.0 (8%) Detec on rate 24% 29% 23% 18% 24% 33% 36% 0% 10% 20% 30% 40% All (N=4,528) FH+ (17%) FH- (83%) <0.6 (25%) 0.6-1.4 (54%) >1.4 (21%) >2.0 (8%) Detec on rate Genetic risk score (GRS) Men without FH 24% 29% 23% 18% 24% 33% 36% 0% 10% 20% 30% 40% All (N=4,528) FH+ (17%) FH- (83%) <0.6 (25%) 0.6-1.4 (54%) >1.4 (21%) >2.0 (8%) Detec on rate Prostate Cancer Prevention Trial (PCPT) Stratification of Susceptibility Genetic risk score: based on risk-associated genotype  Risk for prostate cancer  Family history  PSA level : Low-risk: PSA<6; Intermediate-risk: PSA10-20; High-risk: PSA>20  Only 30% of patients with high PSA have prostate cancer diagnosed after biopsy.  Nearly 90% of men with PSA-detected prostate cancer undergo early treatment with surgery, radiation, or androgen-deprivation therapy. Precision Prediction (1) Primary prevention (2) Secondary prevention (3) Tertiary prevention  Aiding the prognosis that help to establish appropriate clinical treatment decision and cancer management strategy