Utility of Biopsy-Based Genomic Assays to Risk Stratify Patients for Active Treatment

Tissue-based biomarkers have become integral in the prognosis and treatment planning for prostate cancer (PCa), offering insights beyond standard clinicopathologic variables. Prolaris, Oncotype DX, Decipher, and Confirm MDx are genomic tests used in PCa management. These tests utilize various molecular approaches to assess the risk of high-grade disease, metastasis, and cancer-specific survival. While these tests have shown promise, challenges persist, including the lack of prospective data demonstrating their clinical superiority and limited evaluation in focal therapy (FT) settings. Despite these challenges, Decipher, Oncotype DX, and Prolaris have garnered substantial supporting data, influencing treatment decisions in a significant proportion of cases. The National Comprehensive Cancer Network guidelines recommend their consideration in specific risk categories. There are no data pertaining to these tests in the FT setting. Future research may provide additional evidence on their utility, solidifying their role in personalized PCa care.