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Biochemical recurrence can be a clinical tightrope walk. The latest Oncology Decoded episode highlights prostate-specific membrane antigen (PSMA) PET imaging, offering a practical, expert-led exploration of how this advanced modality is moving beyond theoretical benefits to become a cornerstone in the management of advanced prostate cancer.

Manojkumar Bupathi, MD, MS, executive cochair of the Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute (SCRI) and medical oncologist with Rocky Mountain Cancer Centers specializing in solid tumors and genitourinary cancers;

Benjamin Garmezy, MD, associate director of genitourinary research and executive cochair of the Genitourinary Cancer Research Executive Committee at SCRI and medical oncologist at SCRI Oncology Partners specializing in genitourinary cancers, underscored the curative potential of adjuvant therapy in kidney cancer; 

Mike Lattanzi, MD, a genitourinary medical oncologist from Texas Oncology; 

Damian N. Sorce, MD, a urologist from Colorado Urology.

A key theme throughout the episode was the practical application of PSMA PET scans. The panelists share their experiences and insights on how PSMA imaging is impacting risk stratification in patients with prostate cancer. They discuss its role in identifying early metastatic disease, particularly in the context of biochemical recurrence after primary treatment. The ability of PSMA PET to detect bone lesions and lymph node involvement with greater sensitivity and specificity compared with conventional imaging is highlighted as a significant advantage in guiding treatment decisions.

The conversation touches upon the integration of PSMA imaging with established treatment modalities, such as androgen deprivation therapy (ADT) and radiation therapy. The experts discuss how PSMA findings can influence the timing and extent of these treatments, potentially leading to more personalized and effective approaches. For instance, the identification of oligometastatic disease through PSMA PET may guide the use of targeted therapies like stereotactic body radiation therapy (SBRT) in conjunction with systemic therapies.

Risk stratification emerges as a crucial aspect of utilizing PSMA imaging effectively. The panelists discuss how PSMA results can help differentiate between patients with localized recurrence amenable to salvage therapy and those with more widespread disease requiring systemic intervention. This improved risk assessment allows clinicians to tailor treatment strategies, potentially avoiding overtreatment in some cases and ensuring timely and aggressive therapy in others.

The importance of a multidisciplinary care team is implicitly underscored throughout the discussion. The interaction between urologists and oncologists, as represented by the panelists, highlights the need for seamless collaboration in interpreting PSMA imaging results and formulating comprehensive treatment plans for patients with advanced prostate cancer.

Experts weigh in on the practical applications of PSMA PET imaging

Sharpening the Prostate Cancer Toolkit: Practical Insights on PSMA Imaging  

Audio content above is prompted by the following: 

Prolaris Genomic Testing: Clinical Implications for Prostate Cancer Management

Prolaris represents a significant advancement in prostate cancer genomic biomarker platforms, offering unique capabilities in:

Quantitative assessment of cancer aggressiveness through cell-cycle progression gene expression analysis

Precise prediction of absolute benefit from androgen deprivation therapy (ADT) when combined with radiation therapy

Providing actionable clinical information that goes beyond traditional risk stratification methods

Clinical Utility and Practice-Changing Insights

Patients with intermediate-risk prostate cancer considering radiation therapy

Patients with uncertainties about additional treatment necessities

Cases where traditional risk stratification methods provide insufficient guidance

Offers a more nuanced approach to treatment decision-making

Enables personalized treatment strategies by accurately quantifying individual cancer progression risk

Supports more targeted use of ADT, potentially reducing overtreatment

Continued refinement of genomic testing methodologies

Increasing integration of molecular insights into treatment algorithms

Potential for more precise, individualized treatment planning

Stay informed about latest genomic testing advancements

Understand the specific molecular mechanisms underlying Prolaris testing

Integrate genomic insights with traditional clinical parameters

Maintain a patient-centered approach to treatment decision-making

Incorporate Prolaris testing as a complementary tool in prostate cancer management, particularly for patients in intermediate-risk categories where treatment decisions require additional precision.

Expert Panel: Role of Genomics and Genetics in Prostate Cancer

Steven E. Finkelstein, MD, DABR, FACRO discuses how Prolaris distinguishes itself from other genomic biomarker platforms by providing uniquely actionable clinical information that quantifies the absolute benefit of androgen deprivation therapy when added to radiation therapy, offering clinicians a more precise tool for personalizing prostate cancer treatment strategies.

Prolaris in Practice: Guiding ADT Benefits, Clinical Application, and Expert Insights From ACRO 2025

Clinical Cell-Cycle Risk Score: Evolving Prostate Cancer Risk Stratification

The clinical cell-cycle risk (CCR) score represents a significant paradigm shift in prostate cancer risk assessment, moving beyond traditional NCCN risk groups by providing:

More nuanced molecular-level risk evaluation

Personalized treatment stratification based on cellular proliferation characteristics

Enhanced precision in predicting metastatic potential

Radiation Therapy and Androgen Deprivation Therapy (ADT)

May not significantly benefit patients with CCR scores below the multimodal threshold

Challenges traditional combination therapy approaches

Enables more targeted treatment intensification strategies

When evaluating Prolaris reports, clinicians should:

Carefully assess absolute risk reduction metrics

Consider individual patient priorities and potential ADT adverse effects

Establish personalized clinical thresholds for treatment escalation

Balance potential survival benefits against quality-of-life implications

Future Outlook: Genomic Testing Developments

Anticipated advancements in the next 5 years include:

More sophisticated genetic and genomic testing methodologies

Enhanced molecular markers for precise risk stratification

Increased integration of molecular profiling into standard clinical decision-making

Stay current with emerging genomic research

Develop expertise in interpreting molecular risk scores

Integrate comprehensive patient-specific factors beyond traditional risk groups

Maintain flexibility in treatment approach based on evolving molecular insights

Alvaro Martinez, MD discusses how emerging genomic risk stratification tools such as the clinical cell-cycle risk (CCR) score are transforming personalized prostate cancer treatment by enabling more nuanced assessments of metastasis risk and treatment intensification strategies beyond traditional NCCN risk groupings.

CCR Scores and Beyond: Precision Strategies for Treatment Intensification in Prostate Cancer

Genomic Testing in Prostate Cancer Active Surveillance

Traditional clinical parameters are now augmented by genomic testing, providing a more nuanced approach to active surveillance patient selection. Genomic panels such as Prolaris offer critical insights that extend beyond conventional risk factors, allowing for:

When genomic testing results differ from conventional clinical parameters:

Prioritize comprehensive molecular risk assessment

Establish clear genomic score thresholds for surveillance confidence

Conduct thorough patient counseling about potential risks and benefits

Consider additional diagnostic information (repeat biopsy, advanced imaging)

Utilize molecular markers to refine risk stratification

Look beyond traditional Gleason scores and prostate-specific antigen levels

Incorporate genomic proliferation scores and genetic mutation analyses

Anticipated developments in the next 5 years:

More sophisticated machine learning algorithms for risk prediction

Potential for personalized treatment algorithms based on genetic profiling

Stay updated on latest genomic testing technologies

Develop multidisciplinary approach to interpretation

Engage in continuous education about molecular diagnostics

Implement flexible decision-making protocols that incorporate genomic insights

Factors to consider when recommending active surveillance based on genomic testing:

Concordance with traditional clinical parameters

The integration of genomic testing represents a paradigm shift in prostate cancer management, moving toward truly personalized precision medicine.

Daniel Kim, MD, MBA discusses how genomic testing has revolutionized patient selection for active surveillance by integrating molecular insights that transcend traditional clinical parameters, enabling more nuanced risk stratification and personalized management of intermediate-risk prostate cancer.

Precision Active Surveillance: Leveraging Genomic Testing and CCR Scores in Prostate Cancer Management

Emerging Genomic Testing Advances: Clinical Implications for the Next 5 Years

Genomic testing is expected to become increasingly sophisticated in predicting individual disease risks and treatment responses. Clinicians should anticipate:

More comprehensive genetic screening panels that can identify nuanced disease predispositions

Enhanced ability to customize treatment protocols based on individual genetic markers

Improved risk stratification for complex conditions such as cancer, cardiovascular diseases, and neurological disorders

The next 5 years will likely see significant advances in using genetic information to optimize pharmaceutical interventions:

More precise medication selection based on genetic metabolic profiles

Reduced adverse drug reaction risks through genetic screening

Development of targeted therapies that align with specific genetic mutations

Early Detection and Preventive Strategies

Genomic testing will continue to evolve as a powerful tool for early disease detection and prevention:

More sensitive screening methods for detecting presymptomatic genetic variations

Enhanced predictive models for hereditary condition risks

Improved genetic counseling approaches integrating complex genomic data

Recommended Physician Preparation Strategies

Invest in continuous education about genomic testing technologies

Develop skills in interpreting complex genetic data

Stay current with emerging genomic research and clinical guidelines

Upgrade clinical information systems to handle complex genomic data

Implement robust data privacy and security protocols

Develop interdisciplinary collaboration frameworks with genetic specialists

Dwight E. Heron, MD, MBA, FACRO, FACR discusses how advanced multi-omics approaches, personalized precision medicine techniques, artificial intelligence–driven genetic interpretation tools, and emerging gene editing technologies such as CRISPR (clustered regularly interspaced short palindromic repeats) are poised to revolutionize clinical practice by enabling more targeted diagnostics, predictive risk assessments, and individualized treatment strategies across oncology, rare disease management, and chronic condition prevention.

Prostate Cancer

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