Tissue-based gene expression testing in localized prostate cancer.

Purpose of review: This review presents the latest research in tissue-based genomic testing in localized prostate cancer (PCa). Here we explore the current and most commonly used genomic assays, their clinical applications, current challenges, and the future of genomic testing.

Recent findings: The management of localized PCa has evolved with the integration of genomic assays, offering a more personalized approach to risk stratification and treatment decision-making. Traditional clinical markers such as PSA levels and Gleason scores are often insufficient in capturing clinically significant cancer due to disease heterogeneity.

Summary: Tissue-based genomic tests, such as Decipher, Oncotype DX (GPS), and Prolaris, have emerged as prognostic tools for assessing tumor aggressiveness and metastatic potential. Current evidence supports Decipher's prognostic capabilities with studies demonstrating risk stratification while further research is needed for Prolaris and GPS to solidify their role in PCa risk stratification. These assays are intended to guide therapeutic choices, reducing overtreatment in low-risk cases while identifying high-risk patients who may benefit from more aggressive or definitive intervention. Despite growing clinical adoption, challenges such as cost, disparities in access, and variability in physician utilization still remain. Further prospective studies and randomized trials are required to optimize clinical implementation and validate the long-term impact of genomic testing on PCa outcomes.