Episode # 3 • 17 Jan 2025
Biomarkers in Treatment Intensification for Prostate Cancer
Same risk group, very different benefit. Can biomarkers help identify who needs treatment intensification in prostate cancer? On this episode of BackTable Urology, Dr. Ruchika Talwar and Dr. Angela Jia, a radiation oncologist at University Hospitals Cleveland Medical Center, break down the difference between prognostic and predictive biomarkers and how genomic testing is informing the way clinicians counsel patients. They review trial data suggesting that men with a low genomic score may gain little from adding hormone therapy, along with early prospective evidence that the luminal B subtype may help identify who benefits most from intensification.
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Timestamps
00:00 - Introduction
02:08 - Prognostic vs. Predictive Biomarkers
06:34 - The NRG/RTOG 0815 Biomarker Cohort
10:15 - Applying a Low Genomic Score in Clinic
15:16 - Genomic Classifiers After Prostatectomy
18:52 - RTOG 9601, SPPORT and the Salvage Evidence
24:39 - Stage Migration and the Case for an ARPI
28:13 - Ordering and Reading the Genomic Report
34:31 - Common Mistakes in Interpretation
37:31 - Where Genomics Could Go Next
41:03 - Reflex Testing, EMR Integration and AI
44:44 - Closing Remarks
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More about this episode
The conversation covers practical application of test results, counseling with absolute risk numbers, and the pitfalls of stretching predictive claims beyond their evidence. Dr. Jia explains the limits of biopsy sampling, how stage migration with advanced imaging may shift baseline risk, and why a large portion of the genomic score remains unexplained by standard variables. The episode closes with a look at reflex testing, the potential role of AI, and the longer-term goal of giving patients clear, individualized benefit estimates for each treatment option.
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