Future Directions in Prostate Cancer Management: An Evolving Treatment Landscape


Closing out his discussion on prostate cancer, Michael S. Leapman, MD, MHS, highlights practical advice and shares hope for future improvements in the treatment landscape.


Michael S. Leapman, MD, MHS: I do think these data and efforts in improving the precision of prostate cancer management will improve patient outcomes for multiple reasons. The first is that historically, we have undertreated and overtreated prostate cancer. Meeting in the middle and making sure we match the intensity of our management and treatment to a patient’s disease biology, their needs and preferences, is critical and will improve the precision of how we deliver prostate cancer care, as well as the value of how we deliver prostate cancer care.

One of the compelling needs that has been found in work we’ve done is we need to make improvements in how we communicate with our patients. Ultimately, these tools exist to help doctors and patients make better clinical decisions. Some of our earlier work this year has revealed interesting barriers encountered by patients when receiving and [understanding] very complex results. Clinicians are also faced with interpreting a lot of information and relaying it to our patients. We’re not often trained or taught how best to do that. When you talk to patients and ask them what they got out of testing, sometimes you hear mixed messages. For some patients, they find the information to be incredibly helpful, clarifying, and it helps move their care in a certain direction. For others, the communication may be thin or poor and leave lots of questions and even raise uncertainty and anxiety. I think in the future, there is great promise in improving and standardizing how we communicate these results to patients and how best to make practical decisions with this information.

It’s a very exciting time in prostate cancer. There are multiple new treatments and diagnostic modalities. I think that through diagnosis alone, we can really move the needle. I think the story that’s unfolded within the past decade with prostate MRI and precision biopsy is poised to change the precision with how we manage prostate cancer. We see this again with next-generation imaging and prostate cancer, which is, to this very moment, changing the way that we manage high-risk and recurrent prostate cancer. I think the future is bright, and the story will continue to mature and unfold in interesting ways.

I do think this type of work can help develop new targets in prostate cancer. The reason being that, as we get more clinical data, more information at large scale, and can understand how patients responded to a specific therapy, there is the opportunity to identify patterns or profiles of response to treatment, or more of a predictive signal. I think that is a very promising next direction for the Decipher Prostate Genomic Classifier as well as multiple other platforms that should provide information about patient response and customizing how care is delivered.

One of the most practical and simple considerations for using genomic classifiers or gene expression tests in practice is again, that communication question. How do we relay this information effectively to patients? I think some of the messages are that simplicity is key. These tests convey a lot of complex information about predictions, 95% confidence intervals, uncertainty, boundaries, and histograms. What we found is that the level of detail can sometimes be overwhelming, both for clinicians and especially for patients. When communicating this information, a simplistic approach and reiterating qualitative descriptions of high versus low risk can be very effective and helpful at bridging information gaps between patients and their doctors.

Transcript edited for clarity.

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