Genomic testing for localized prostate cancer: where do we go from here?

The goal of this article is to discuss current genomic testing options in localized prostate cancer.

There are multiple genomic tests currently available for men with localized prostate cancer. Prolaris, OncotypeDx, and Decipher can all be tested using biopsy tissue. Prolaris and Decipher are also available for men undergoing radical prostatectomy to predict subsequent disease progression.

The Prolaris cell cycle progression score measured on biopsy predicts the risk of prostate cancer death in 10 years with conservative management, whereas, the primary endpoint for the OncotypeDx genomic prostate score is the risk of adverse disease at radical prostatectomy. Decipher measures genome-wide RNA expression, and its Genomic Classifier signature was initially designed to predict the risk of metastasis for men with adverse disease at radical prostatectomy, and more recently, a biopsy version was released. Recently, Decipher signatures predicting prostate cancer cell lineage and postoperative radiation sensitivity have also been described. Any of these tests can be used by men with localized prostate cancer to provide additional prognostic risk stratification to aid in treatment decisions.