CALCULATING PROSTATE CANCER RISK, AVOIDANCE OF OVERTREATMENT IN LOCALIZED PROSTATE CANCER: Edited by Matthew R. Cooperberg and Declan G. MurphyTissue-based genomics which test and whenVince, Randy A. Jra; Tosoian, Jeffrey J.a; Jackson, William C.b; Spratt, Daniel E.b; Morgan, Todd M.a Author Information aDepartment of Urology bDepartment of Radiation Oncology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA Correspondence to Todd M. Morgan, MD, Department of Urology, University of Michigan, 1500 E Medical Center Drive, CCC 7308, Ann Arbor, MI 48109, USA. Tel: +1 734 615 6662; e-mail: [email protected] Current Opinion in Urology: November 2019 - Volume 29 - Issue 6 - p 598-604 doi: 10.1097/MOU.0000000000000673 Buy Metrics Abstract Purpose of review The clinical course of localized prostate cancer varies widely, ranging from indolent disease unlikely to require treatment to aggressive cancers meriting intensive, multimodal therapy. Management recommendations have traditionally been determined based on clinical and pathologic factors, including serum prostate - specific antigen (PSA), clinical stage, and Gleason score. Unfortunately, these factors have limited ability to describe the underlying biology of a given tumor. Tissue-based genomic tests have emerged as a promising tool to more accurately characterize prostate cancer biology and projected clinical course. The current review article summarizes available data describing the clinical use of genomic assays, with a specific focus on three critical scenarios. Recent findings We reviewed the potential role of tissue-based genomic assays in determining: the appropriateness of active surveillance versus definitive therapy, patients that will benefit from adjuvant radiation therapy following radical prostatectomy, and men most likely to benefit from concurrent androgen deprivation therapy with primary radiotherapy. Summary Current literature suggests that commercially available genomic tests provide prognostic information independent of traditional risk factors that may augment clinical decision-making. Additional data will better clarify the optimal use of each test across common clinical scenarios. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.