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PEER-TO-PEER CLINICAL CONVERSATIONS
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From Testing to Treatment: Implementing Genomics and AI Tools in Prostate Cancer Care
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Elisabeth Heath, MD, FACP
Elisabeth Heath discusses how genomic classifiers and AI-based biomarkers may support treatment intensification and de-intensification decisions across localized and advanced prostate cancer. She emphasizes multidisciplinary interpretation, integration with clinical features and patient comorbidities, and the evolving evidence for applying these tools in routine practice.
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STAMPEDE and ENZARAD in High-Risk Localized Prostate Cancer
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Christopher Sweeney, MBBS, and Jeff Michalski, MD, MBA, FACR, FASTRO
Christopher Sweeney and Jeff Michalski review STAMPEDE and ENZARAD data on adding potent androgen receptor pathway inhibition to ADT and radiotherapy in high-risk localized prostate cancer. They discuss how differences in patient risk, nodal involvement, imaging, and emerging genomic and AI biomarkers may help identify patients for treatment intensification or de-intensification.
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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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| Image-only and multimodal AI models demonstrated consistent prognostic performance for 10-year distant metastasis and prostate cancer-specific mortality across active surveillance, radical prostatectomy, and radiation therapy. Higher AI scores were associated with greater risk in each management group, supporting further study of these tools for refining risk assessment and treatment-intensity decisions.
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| Clinico-Transcriptomic Risk Stratification to Guide Abiraterone Treatment Intensification in High-Risk Prostate Cancer: A Combined Analysis of NRG/RTOG 9202, 9413, 9902, and 0521
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| Krishnan Patel, MD
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| In a combined analysis of NRG/RTOG trials, a 22‑gene genomic classifier independently improved prediction of metastasis-free survival, distant metastasis, and overall survival beyond clinical risk, and about 25% of patients had discordant clinical and genomic risk, highlighting the need for integrated decision tools.
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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 an ENZAMET analysis, a Decipher Prostate Metastatic Classifier score greater than 0.85 was associated with poorer outcomes among patients receiving ADT plus enzalutamide. After adjustment for clinical differences, patients with scores above 0.85 appeared to derive greater benefit from the addition of docetaxel, supporting further evaluation of genomic risk to inform triplet-therapy decisions.
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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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| In a SEER–Decipher linked population-based cohort of 2,547 men with low- or favorable intermediate-risk prostate cancer, higher 22-gene Decipher scores were independently associated with substantially lower odds of initial active surveillance versus immediate treatment, even after adjusting for standard clinical and demographic factors.
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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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| In 123 post-prostatectomy men with biochemical recurrence, PAM50 Luminal B tumors had the highest Decipher scores and the greatest proportion of high-risk Decipher, while a substantial share of Non–Luminal B tumors also met common Decipher thresholds used to support adding ADT to salvage radiotherapy.
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| Practice Patterns and Outcomes by Genomic Risk in Octogenarians with High-Risk Localized Prostate Cancer: A National Real-World Data Analysis
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| Zachary Moore, MD, PhD
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| In a national real-world cohort of 1,519 octogenarians with NCCN high/very high-risk localized prostate cancer, Decipher genomic classifier results were strongly associated with both management patterns and outcomes: patients with low genomic risk were observed 38% of the time and had significantly better freedom from distant metastases, metastasis-free survival, and overall survival, including <5% 5-year risk of metastasis with observation alone, whereas genomic high/intermediate patients had worse outcomes regardless of being observed or treated.
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