Ep. 336 Biomarkers in Treatment Intensification for Prostate Cancer with Dr. Angela Jia

Same risk group, very different benefit. Can biomarkers help identify who needs treatment intensification in prostate cancer? On this episode of BackTable Urology, Dr. Ruchika Talwar and Dr. Angela Jia, a radiation oncologist at University Hospitals Cleveland Medical Center, break down the difference between prognostic and predictive biomarkers and how genomic testing is informing the way clinicians counsel patients. They review trial data suggesting that men with a low genomic score may gain little from adding hormone therapy, along with early prospective evidence that the luminal B subtype may help identify who benefits most from intensification. --- Get the BackTable app https://www.backtable.com/app --- This podcast is supported by Verasyte https://www.veracyte.com/ --- Timestamps 00:00 - Introduction 02:08 - Prognostic vs. Predictive Biomarkers 06:34 - The NRG/RTOG 0815 Biomarker Cohort 10:15 - Applying a Low Genomic Score in Clinic 15:16 - Genomic Classifiers After Prostatectomy 18:52 - RTOG 9601, SPPORT and the Salvage Evidence 24:39 - Stage Migration and the Case for an ARPI 28:13 - Ordering and Reading the Genomic Report 34:31 - Common Mistakes in Interpretation 37:31 - Where Genomics Could Go Next 41:03 - Reflex Testing, EMR Integration and AI 44:44 - Closing Remarks --- More about this episode The conversation covers practical application of test results, counseling with absolute risk numbers, and the pitfalls of stretching predictive claims beyond their evidence. Dr. Jia explains the limits of biopsy sampling, how stage migration with advanced imaging may shift baseline risk, and why a large portion of the genomic score remains unexplained by standard variables. The episode closes with a look at reflex testing, the potential role of AI, and the longer-term goal of giving patients clear, individualized benefit estimates for each treatment option. --- Resources NRG/RTOG 0815: A Phase III Prospective Randomized Trial of Dose-Escalated Radiotherapy With or Without Short-Term Androgen Deprivation Therapy for Patients With Intermediate-Risk Prostate Cancer (trial record) https://clinicaltrials.gov/study/NCT00936390 NRG-GU006 (BALANCE): A Phase II Randomized Trial of Salvage Radiotherapy With or Without Apalutamide in Recurrent Prostate Cancer (trial record) https://clinicaltrials.gov/study/NCT03371719 Feng FY, et al. Validation of a 22-Gene Genomic Classifier in Patients With Recurrent Prostate Cancer: An Ancillary Study of the NRG/RTOG 9601 Randomized Clinical Trial. JAMA Oncol. 2021 https://pubmed.ncbi.nlm.nih.gov/33570548/ Pollack A, et al. The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT). Lancet. 2022 https://pubmed.ncbi.nlm.nih.gov/35569466/ Zhao SG, et al. Associations of Luminal and Basal Subtyping of Prostate Cancer With Prognosis and Response to Androgen Deprivation Therapy. JAMA Oncol. 2017 https://pubmed.ncbi.nlm.nih.gov/28494073/ Patel KR, Nguyen PL, et al. Biopsy-based Basal-luminal Subtyping Classifier in High-risk Prostate Cancer: A Combined Analysis of the NRG Oncology/RTOG 9202, 9413 and 9902 Phase 3 Trials. Eur Urol Oncol. 2026 https://pubmed.ncbi.nlm.nih.gov/39542826/ Grist E, et al. Tumor transcriptome-wide expression classifiers predict treatment sensitivity in advanced prostate cancers (STAMPEDE). Cell. 2025 https://pubmed.ncbi.nlm.nih.gov/40865526/ Jia AY, et al. Cross-Comparison Individual Patient-Level Analysis of Three Gene Expression Signatures in Localized Prostate Cancer in Over 50,000 Men. JCO Precis Oncol. 2025 https://pubmed.ncbi.nlm.nih.gov/40479622/ Dr. Angela Jia, University Hospitals physician profile https://www.uhhospitals.org/doctors/Jia-Angela-1902338718 Dr. Ruchika Talwar, BackTable Urology contributor page https://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app