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Together, these data support a combined use of clinical risk and genomic risk assessment in the management of men with localized prostate cancer, and illustrate the shortcomings of clinical risk groups, especially within the intermediate and high risk groups. Some men with intermediate risk PC have a low genomic risk and do well, while others behave more like high risk disease. Combined with existing RP data around metastasis risk, these data continue to support clinical trials of using the Decipher assay to investigate intensifying therapy for high risk men, such as with novel AR inhibitors or novel systemic approaches, in combination with radiation and ADT. These studies also support potentially de-escalating care in low risk men. Before making such treatment decisions, however, prospective studies testing these biomarker-driven clinical algorithms are needed in defined settings. I suspect that future treatment algorithms will be improved upon through the use of such genomic risk biomarkers and lead to better outcomes for our patients based on their personalized risk.
Written by: Andrew Armstrong, MD, ScM, medical oncologsits and Associate Professor of Medicine, Surgery, Pharmacology and Cancer Biology at Duke University. Dr. Armstrong is also the Associate Director of the Duke Cancer Institute Genitourinary Clinical Research Program. He is internationally recognized expert in experimental therapeutics and biomarker development in genitourinary cancers, particularly in prostate cancer.
Read the PCAN Full Text Article: Utilization of Biopsy-Based Genomic Classifier to Predict Distant Metastasis after Definitive Radiation and Short-Course ADT for Intermediate and High-Risk Prostate Cancer