How Genomic Testing is Transforming Treatment Decisions in Intermediate-Risk Prostate Cancer

By Lauren Lenz, Christina Nakamoto, & Robert Finch

In men with prostate cancer, few decisions are as difficult—or as emotionally charged—as choosing between active surveillance and definitive treatment. This is especially true for men with intermediate-risk prostate cancer, where the risks and benefits are often uncertain.

A recent study published on UroToday explores how genomic testing—specifically the Prolaris^® Prostate Cancer Prognostic Test—can help bring clarity to this decision-making process.

Why Was This Study Important?

Historically, treatment decisions for prostate cancer have relied on clinical indicators like PSA levels, Gleason scores, and risk stratification tools such as University of California, San Francisco’s Cancer of the Prostate Risk Assessment (CAPRA) and National Comprehensive Cancer Network guidelines (NCCN). But for men with prostate cancer, especially intermediate-risk patients, these tools are not enough. The risk level is unclear, potentially leading to anxiety.¹ Choosing active surveillance when prostate cancer is more aggressive than it appears can lead to undertreatment; choosing definitive treatment when it’s not needed can lead to unnecessary side effects and reduced quality of life.¹ The study also demonstrated that integrating molecular information with CAPRA, the Prolaris Test accurately distinguishes patients with biologically aggressive tumors from those with indolent disease who may safely avoid overtreatment.¹

This study was designed to answer a critical question: Can genomic testing with the Prolaris Test improve confidence in treatment decisions for intermediate-risk patients—and does that confidence translate into durable outcomes?

What the Study Found

The Prolaris Test uses a Combined Clinical Risk (CCR) score, integrating molecular information with CAPRA.
Among 3,208 men with intermediate-risk prostate cancer: 45.8% were identified as safe for active surveillance. Of those, 41.8% chose surveillance. Further, 79.3% of those found to be candidates for definitive therapy pursued treatment.
Patients who were identified as appropriate for active surveillance by the Prolaris Test were twice as likely to follow active surveillance compared to those who didn’t receive the test.
At three years of follow-up, individuals were about 1.5 times more likely to still be on active surveillance if the Prolaris Test initially identified them as appropriate for active surveillance.

Figure 1. AS durability by Prolaris treatment recommendation over 3 years among men who initially selected AS.²

See the full retrospective study here.

Why It Matters

The study shows that when patients and providers have access to personalized genomic insights, they’re more likely to use this information in their decision-making. And patients who chose active surveillance based on recommendations from Prolaris Testing were more likely to remain on that path three years later.

What Can We Learn?

This study is a compelling case for the value of precision medicine. It demonstrates how tools like the Prolaris Test can:

Reduce decision fatigue for patients and providers.
Support shared decision-making with data-driven confidence.
Improve long-term adherence to treatment plans.

The Bigger Picture

As genomic testing becomes more accessible and integrated into clinical workflows, we’re moving toward a future where treatment is tailored, not templated. That’s a win for patients—and a call to action for healthcare providers.

Learn how to incorporate the Prolaris Test into your practice today.

References:

Bangma C H, et al. Overdiagnosis and overtreatment of early detected prostate cancer. World J Urol. 2007 Feb 14;25(1):3–9. doi: 10.1007/s00345-007-0145-z
Lenz, L., Clegg, W., Iliev, D. et al. Active surveillance selection and 3-year durability in intermediate-risk prostate cancer following genomic testing. Prostate Cancer Prostatic Dis 28, 427–434 (2025). https://doi.org/10.1038/s41391-024-00888-y