Use of Biomarkers: Genomic Testing to Delete ADT with Radiation

How to cite: Tward JD. Use of Biomarkers: Genomic Testing to Delete ADT with Radiation. Grand Rounds in Urology. February 2026. Accessed Mar 2026. https://grandroundsinurology.com/use-of-biomarkers-genomic-testing-to-delete-adt-with-radiation/

Summary

Jonathan D. Tward, MD, PhD, FASTRO, Professor of Radiation Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, explains how prognostic and predictive biomarkers may help determine when androgen deprivation therapy (ADT) can be omitted in patients receiving radiation therapy.

Dr. Tward discusses the role of genomic and biomarker testing in guiding decisions about ADT with radiation therapy for localized prostate cancer. He explains how clinicians traditionally rely on National Comprehensive Cancer Network risk group classifications to determine treatment intensity. These groupings categorize patients as low risk, favorable intermediate risk, or unfavorable intermediate risk, and guide decisions regarding observation, monotherapy, or treatment intensification, which may include ADT.

Dr. Tward emphasizes that risk group classifications represent average outcomes for populations rather than individualized patient risk. He notes that individual patient risk within each category can vary widely.

He distinguishes between prognostic and predictive biomarkers. Prognostic biomarkers estimate the likelihood of outcomes such as metastasis independent of treatment choice, while predictive biomarkers evaluate whether adding a specific therapy is likely to produce a meaningful treatment effect. In the context of radiation therapy, predictive biomarkers may help determine whether ADT will meaningfully improve outcomes.

Dr. Tward reviews the currently available genomic tests that provide individualized estimates of metastasis risk, including ArteraAI, Prolaris®, Genomic Prostate Score, and Decipher®. He explains that while all provide prognostic risk estimates, only some assays attempt to model the potential benefit or futility of ADT.

Dr. Tward proposes a framework in which individualized metastasis risk estimates guide decisions about treatment intensification and the use or omission of ADT with radiation therapy.

 

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