Treatment of Prostate Cancer: Approaches in Localized Disease - Experts Discuss

How should clinicians approach treatment decisions for localized prostate cancer when new imaging technologies, genomic biomarkers, and salvage treatment strategies continue to evolve? In this panel discussion from the 36th Annual International Prostate Cancer Update, experts review practical questions on radiation therapy approaches for prostate cancer. The group addresses questions regarding the clinical implementation of magnetic resonance imaging (MRI)-assisted radiosurgery (MARS) and whether elements of MRI-guided workflows can be adopted in centers without intraoperative MRI capability. Panelists note that early post-implant imaging, including day-zero MRI, may help physicians assess brachytherapy implant quality and improve treatment planning. The panel also addresses common misconceptions regarding treatment options after prior radiation therapy. Panelists emphasize that both surgery and additional radiation therapy may be possible in selected patients, depending on disease characteristics and clinical context. Additional discussion focuses on genomic classifiers such as Decipher and their integration into clinical trials evaluating treatment intensification or de-intensification strategies. Panelists explain that genomic risk thresholds used in clinical trials may differ from those used in standard clinical reporting. Several audience questions focus on prostate-specific antigen doubling time, salvage treatment decisions, and the potential role of predictive biomarkers in guiding treatment selection between surgery and radiation therapy. Don't forget to join the GRU Community: https://grandroundsinurology.com/regi... Follow us on Twitter/X: https://x.com/GRUrology And like and subscribe to us here on YouTube!