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Decision-Making and Multidisciplinary Counseling for Nodal Involvement on PSMA PET

A panelist discusses how, for high-risk localized prostate cancer with questionable lymph node involvement, radiation therapy combined with systemic treatment may be preferable to radical prostatectomy due to the ability to treat a wider field of potential microscopic disease.

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      Genomic Classifiers in Treatment Decision-Making

      This segment emphasizes the critical role of genomic classifiers in guiding treatment intensification decisions for patients with high-risk localized prostate cancer. Multiple randomized controlled trials have demonstrated that patients with high-risk genomic classifier results benefit significantly from treatment intensification beyond standard androgen deprivation therapy. These molecular tools help identify patients most likely to benefit from additional systemic therapy while avoiding overtreatment of those with more favorable biological profiles.

      The field of genomic testing continues to evolve rapidly, with tissue-based markers currently providing robust data for clinical decision-making. Emerging artificial intelligence–based markers promise even greater precision in patient selection and treatment personalization. These advances represent a shift toward precision medicine approaches in prostate cancer management, moving beyond traditional clinical and pathological factors alone.

      Appropriate patient selection becomes crucial as treatment options expand, ensuring that intensive therapies are reserved for those most likely to benefit. Genomic classifiers provide objective, reproducible data to support clinical decision-making, helping oncologists balance the potential benefits of treatment intensification against the risks of overtreatment. This personalized approach optimizes outcomes while minimizing unnecessary treatment burden for patients with more favorable disease biology.

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