Dr. Claire de la Calle

But there are several studies that suggest that if you have perinatal invasion and gray group 2, you're going to have more adverse pathology at radical prostatectomy.

At the University of Washington, unfortunately, we do not report perinatal invasion on our biopsy reports.

We felt like it was causing a lot of patient anxiety.

This was many years ago, so maybe that will change back to putting it in our biopsy reports.

So I don't use it as an exclusion criteria because I think the evidence is not as strong.

But when I do see it in an intermediate risk patient, I just consider it like an additional negative prognostic factor against surveillance.

And I'll proceed with caution with active surveillance.

Definitely.

And there's a lot of nuance regarding the data around these commercially available genomic classifiers and active surveillance.

Certainly in studies of patients that were treated for their prostate cancer, such as the Decipher genomic classifier,

that was looked at in several NRG and RTOG trials.

It seems like these genomic classifiers are fairly good at predicting a 10-year distant metastases rate.

If the score is really low, then the risk is going to be low, whereas if the score is very high,

then the risk is going to be much, much higher.

And we know from real-world data that these genomic classifiers really do change management in our patients with localized prostate cancer.

Specifically in active surveillance, though, I think we still need more

studies that are done in patients that are completely unselected.

So a lot of the studies that we see out there are, yes, in active surveillance patients, but this was what we call opportunistic testing.

So these patients had a reason to get these genomic classifiers done.

So they probably were higher risk to begin with.