Sivanesan Nethusan, Diaz Gabriela M, Sprenkle Preston C
Yale School of Medicine, Department of Urology, New Haven, Connecticut, USA.
Curr Opin Urol. 2025 Jul 1;35(4):432-438. doi: 10.1097/MOU.0000000000001289. Epub 2025 May 2.
This review presents the latest research in tissue-based genomic testing in localized prostate cancer (PCa). Here we explore the current and most commonly used genomic assays, their clinical applications, current challenges, and the future of genomic testing.
The management of localized PCa has evolved with the integration of genomic assays, offering a more personalized approach to risk stratification and treatment decision-making. Traditional clinical markers such as PSA levels and Gleason scores are often insufficient in capturing clinically significant cancer due to disease heterogeneity.
Tissue-based genomic tests, such as Decipher, Oncotype DX (GPS), and Prolaris, have emerged as prognostic tools for assessing tumor aggressiveness and metastatic potential. Current evidence supports Decipher's prognostic capabilities with studies demonstrating risk stratification while further research is needed for Prolaris and GPS to solidify their role in PCa risk stratification. These assays are intended to guide therapeutic choices, reducing overtreatment in low-risk cases while identifying high-risk patients who may benefit from more aggressive or definitive intervention. Despite growing clinical adoption, challenges such as cost, disparities in access, and variability in physician utilization still remain. Further prospective studies and randomized trials are required to optimize clinical implementation and validate the long-term impact of genomic testing on PCa outcomes.
本综述介绍了局限性前列腺癌（PCa）基于组织的基因组检测的最新研究。在此，我们探讨当前最常用的基因组检测方法、它们的临床应用、当前面临的挑战以及基因组检测的未来发展。
随着基因组检测方法的整合，局限性PCa的管理方式不断演变，为风险分层和治疗决策提供了更个性化的方法。由于疾病的异质性，传统的临床标志物如前列腺特异性抗原（PSA）水平和 Gleason评分往往不足以捕捉具有临床意义的癌症。
基于组织的基因组检测，如Decipher、Oncotype DX（GPS）和Prolaris，已成为评估肿瘤侵袭性和转移潜力的预后工具。目前的证据支持Decipher的预后能力，多项研究表明其可进行风险分层，而Prolaris和GPS在PCa风险分层中的作用还需要进一步研究来确定。这些检测旨在指导治疗选择，减少低风险病例的过度治疗，同时识别可能从更积极或确定性干预中获益的高风险患者。尽管临床应用越来越广泛，但成本、获取途径差异以及医生使用的变异性等挑战仍然存在。需要进一步的前瞻性研究和随机试验来优化临床实施，并验证基因组检测对PCa治疗结果的长期影响。
