Use of Genomics for Active Surveillance

First, the doctors summarize how to determine stage and risk of prostate cancer by assessing local and regional staging with MRI and PET-PSMA scans. They discuss the significant role of Gleason grade groups and genetic variants and genetic predisposition for prostate cancer. They underscore the importance of evaluation beyond the microscopic cellular structure of the cancer and using tools like MRI to reduce unnecessary biopsies.

Next, they explain the factors involved in the decision to treat or observe prostate cancer. Dr. Ross shares insights into the three possible lines of progression that prostate cancer can take and how to identify them in a patient. He illuminates the differences between germline and genomic testing, the impact of genomics on treatment decisions, and the crucial role of shared decision making. The doctors also consider the cost of genomics and the patient's expectation of what will happen before making a decision. Although there is a lack of standardization in the qualification and execution of prostate cancer surveillance, national trials are being done nationally that could influence guidelines around the use of genomics and active surveillance.