Ashley E. Ross, MD, PhD

Ashley E. Ross, MD, PhD, discusses genomics—prognostic and predictive markers in non-metastatic prostate cancer. He explains outcomes for localized prostate cancer vary widely and clinical decisions are based on disease risk. He points out genomic factors can provide an individualized risk assessment. Dr. Ross shares the principles of risk stratification within National Comprehensive Care Network (NCCN) guidelines that include gene expression testing (e.g., Decipher 13) and describes the Decipher platform.

Dr. Ross shares prognostic data for Decipher that show an 80% accuracy for predicting metastasis, and explains how this information informs clinical decision-making. He explains that markers can help differentiate men on active surveillance (AS) to guide the intensity of the surveillance or the decision to proceed with treatment. In men with unfavorable intermediate risk disease, data shows genomic information can help determine how much androgen signaling inhibition (if any) is necessary with radiation therapy (RT).

Dr. Ross then explains the GUIDANCE trial and explains that NCCN further stratifies high-risk patients by genomics and explains this is the focus of a longer term trial, PREDICT-RT*. He then turns to who should consider RT at prostate-specific antigen (PSA) <0.1-0.2ng/ml and asserts men with low Decipher genomic risk undergoing early salvage radiation should consider avoiding hormonal therapy. Dr. Ross explains PAM50 is a genomic classifier that identifies subtypes of cancer expression which are common across breast, bladder, prostate, and other cancers. He addresses elements of the TITAN trial as well as the ENACT trial. He concludes that individualized risk stratification drives treatment decisions and outcomes, genomics can provide independent prognostic accuracy, and predictive markers for treatment response are in active development.