Abstract

There is growing interest in using scores, including polygenic scores, to guide individualized treatment selection as well as to avoid treatment toxicity. Many efforts have focused on prognostic scores for this purpose, though predictive scores are a compelling alternative. In this seminar, I will define and compare these two approaches and the implications of using each. Furthermore, comparisons of these two scoring modalities in real trial data are lacking. Given previous work that found a modification of the effect of finasteride on prostate cancer risk by genetic markers, it is important to understand how prognostic and predictive polygenic scores might be used to guide use of finasteride. I utilized data from the Prostate Cancer Prevention Trial (PCPT), a large randomized study of finasteride for the prevention of prostate cancer, to compare the utility of these scores for guiding finasteride use. This analysis of nearly 8,000 PCPT participants found greater utility for the predictive scores. These results provide insights into the relationship between finasteride and prostate cancer risk, as well as an illustration of the potential benefits and challenges of developing polygenic scores for intervention selection.