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PEER-TO-PEER CLINICAL CONVERSATIONS
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Genomic and AI-based tools for prostate cancer treatment decisions.
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Genomic Classifiers and AI for Personalizing Prostate Cancer Radiation Therapy
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Jason Efstathiou, MD, DPhil, FASTRO, FACRO
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| Jason Efstathiou discusses the use of genomic classifiers and AI-based tools in personalizing radiation therapy for prostate cancer.
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Predicting Docetaxel Benefit with a Genomic Classifier in mHSPC
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Christopher Sweeney, MBBS
Christopher Sweeney presents a Decipher® genomic classifier analysis of the ENZAMET trial, applying the 22-gene assay to evaluate whether genomic risk may help identify patients with metastatic hormone-sensitive prostate cancer who derive greater benefit from adding docetaxel to ADT plus enzalutamide.
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PAM50 Intrinsic Subtyping and Salvage Therapy Decisions After Prostatectomy
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Jonathan Tward, MD, PhD
Jonathan Tward presents data using PAM50 molecular classifier in 130 post-prostatectomy biochemical recurrence patients receiving salvage radiation. The analysis showed that Luminal B patients who did not receive ADT experienced metastasis rates of approximately 40%–50% at three to four years, compared with approximately 10% among those who received ADT.
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| Association Between Genomic Classifier Scores and Initial Management of Localized Prostate Cancer in a Population-Based Cohort in the United States
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| Michael Leapman, MD, MHS
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| Michael Leapman presents a study in which higher genomic classifier scores were linked to lower use of active surveillance in this U.S. population-based cohort of men with low- and favorable intermediate-risk prostate cancer. The effect was strongest in intermediate-risk disease, where higher scores were associated with much lower odds of surveillance and more frequent immediate treatment.
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| Assessing the Clinical and Biological Associations Between MMAI and 22-Gene GC in Localized Prostate Cancer
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| Boon Hao Hong
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| In this Singapore cohort of 144 men with localized prostate cancer, MMAI and the 22-gene genomic classifier were moderately correlated but often assigned different risk categories. Despite that discordance, both were prognostic for metastasis-free survival, and the genomic classifier showed broader pathway differences while MMAI-high was mainly linked to lower fatty acid metabolism.
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| Image-Only and Multimodal AI Digital Pathology Biomarkers to Demonstrate Risk Stratification Across Standard Prostate Cancer Management Strategies
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| Xinglei Shen, MD, MS
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| Both the image-only and multimodal AI pathology biomarkers consistently stratified risk across active surveillance, prostatectomy, and radiation therapy in localized prostate cancer. Higher scores were associated with greater distant metastasis and prostate cancer-specific mortality risk, suggesting routine H&E slides contain meaningful prognostic information even without clinical variables.
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| PAM50 Intrinsic Subtyping and Decipher Genomic Classifier in BCR After Prostatectomy: Implications for ADT Selection
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| Jonathan Tward, MD, PhD, FASTRO
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| Jonathan Tward presents a study of men with biochemical recurrence after prostatectomy in which PAM50 subtype tracked with Decipher risk, with Luminal B tumors showing the highest genomic scores and ADT appearing most beneficial in that group. Still, many non–Luminal B tumors also met common Decipher thresholds for adding ADT, so the study suggests ADT should not be withheld solely based on subtype.
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| Genomic Risk Classifier Performance in PET-Guided Post-Prostatectomy Patients: Secondary Analysis of a Randomized Trial
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| Ashesh Jani, MD, MSEE, FASTRO
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| Ashesh Jani presents this secondary analysis in which the genomic risk classifier remained prognostic even in men receiving PET-guided post-prostatectomy radiation, with higher scores linked to worse event-free survival. PET dose escalation appeared beneficial mainly in patients below the higher risk cutoff, suggesting genomic risk may help refine who gains from intensified salvage treatment.
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| Assessment of the Ability of Decipher Prostate Genomic Classifier >0.85 to Identify Patients Who Benefit from Adding Docetaxel to ADT + Enzalutamide: Level 1B Evidence from the ENZAMET Study
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| Christopher Sweeney, MBBS
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| In the ENZAMET biomarker analysis, a Decipher Prostate Metastatic Classifier score above 0.85 identified men with worse outcomes on ADT + enzalutamide alone, and those patients appeared to gain the most from adding docetaxel. Men with scores ≤0.85 did not show clear benefit from docetaxel intensification, suggesting Decipher may help select who should receive triplet therapy.
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