In this Tumor Board Brief, Dr. Neeraj Agarwal, Dr. Parth Modi, and Dr. Tyler Seibert provide a multidisciplinary update on modern management of localized and recurrent prostate cancer, spanning risk stratification, active surveillance, molecular biomarkers, and the evolving treatment landscape for biochemical recurrence (BCR).
The discussion begins with how Decipher and other genomic classifiers are increasingly used to refine prognosis in Grade Group 1–2 disease, including ongoing trials such as GUIDANCE, ENZARAD, and ATLAS, which pair ADT, radiation therapy, and next-generation androgen receptor pathway inhibitors (ARPIs). The panel reviews emerging evidence suggesting that some traditional active surveillance protocols may now be overly intensive—particularly as MRI, PSA dynamics, and genomic risk tools help better identify patients most likely to experience active surveillance failure.
Shifting to post-treatment PSA recurrence, the experts explore how PSMA PET has reshaped decision-making around salvage radiation, systemic intensification, and metastasis-directed therapy (MDT). They outline key trials—including DASL-HICaP, RA-STEP, PRIMORD, and MDT IITs such as TERPS—that aim to clarify when to escalate with lifelong systemic therapy versus when limited-duration ADT and site-directed treatment may be sufficient. The conversation underscores the need to balance oncologic benefit with long-term quality of life as the field awaits definitive trial results.
Contributors:
Dr. Neeraj Agarwal is a professor of medicine, and a Presidential Endowed Chair of Cancer Research at the Huntsman Cancer Institute (HCI), University of Utah. He also directs the Genitourinary Oncology (GU) Program, and the Center of Investigational Therapeutics (CIT) at the HCI.
Dr. Parth Modi is a urologic oncologist at the University of Chicago in Chicago, Illinois.
Dr. Tyler Seibert is a radiation oncologist and Assistant Professor in the the Division of Radiation Oncology at UC San Diego School of Medicine in San Diego, California.
