The Role of Genomic Classifiers in Guiding Therapy for Localized High-Risk Prostate Cancer

EP: 1.A 74-Year-Old Man With Metastatic Castration-Resistant Prostate Cancer (mCRPC)

EP: 2.Assessing Tolerability and Clinical Considerations in Abiraterone Formulation Selection

EP: 3.Formulation Matters: Tailoring Abiraterone Dosing for Optimal Absorption and Tolerability

EP: 4.The Impact of Comorbidities, Adherence, and Access on mCRPC Treatment Decisions

EP: 5.A 62-Year-Old Man With High-Risk Localized Prostate Cancer

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EP: 6.The Role of Genomic Classifiers in Guiding Therapy for Localized High-Risk Prostate Cancer

EP: 7.Decision-Making and Multidisciplinary Counseling for Nodal Involvement on PSMA PET

EP: 8.Managing Abiraterone Intolerance: Alternative Dosing Strategies in Practice

High-Risk Localized Prostate Cancer Case Presentation

This segment introduces a patient aged 62 years with high-risk localized prostate cancer, demonstrating the expanding role of abiraterone beyond metastatic disease treatment. The patient presented with an elevated prostate-specific antigen (PSA) of 25, leading to prostate biopsy revealing Gleason 4+5=9 cancer in 4 of 12 cores. Staging with PSA PET scan showed questionable right-sided pelvic lymph node involvement but no definitive distant metastases, representing a challenging clinical scenario requiring multidisciplinary treatment planning.

The patient’s medical history includes well-controlled hypertension and hyperlipidemia without significant cardiovascular disease or diabetes. Family history reveals paternal prostate cancer, and genomic classifier testing demonstrated high-risk signature, supporting treatment intensification. Physical examination showed good performance status (ECOG 0) with a firm, irregular prostate consistent with high-grade localized disease, making him an appropriate candidate for curative-intent therapy.

After multidisciplinary discussion considering surgery, radiation, and systemic therapy options, the patient elected definitive radiation therapy combined with androgen deprivation therapy. Given high-risk clinical and genomic features, treatment intensification with abiraterone was recommended. The case demonstrates successful PSA response from 25 to 2.1 at 1 month but highlights ongoing challenges with traditional abiraterone tolerability, leading to consideration of alternative formulations.