Precision Medicine Shaping the Future of Prostate Cancer Care

Author is Ola Berger Christiansen.

The first SPCG meeting in precision medicine was held in Copenhagen in September 2025. Precision medicine is developing rapidly and may be helpful for several reasons in prostate cancer diagnostics and treatment. Precision medicine could be defined as 4P medicine: personalized (genetics), predictive, preventive and participatory. The meeting gathered both clinicians and researchers from all the Scandinavian countries. Different topics in precision medicine were highlighted, with focus on ongoing research.

The role of precision medicine in prostate cancer today was part of the first session. Three of the main challenges in prostate cancer are screening, risk-stratification and treatment of metastatic disease. The aim of screening is to detect clinical significant prostate cancer and later on reduce the number of men who develop metastasis. Screening with PSA alone leads to overdiagnosis and increased detection of lowgrade prostate cancer. The future is risk-stratified screening, including polygenetic tests and prostate MRI. Germline testing with polygenetic risk score can identify men who are at risk of developing significant disease and prognostic biomarkers can identify men who benefit the most (or overall) of treatment. And, even more importantly, clinicians will presumably be able to identify men that do not benefit of treatment. Consequently, fewer men will be offered treatment of localized prostate cancer and potentially bothersome adverse effects are avoided.

The last session of the first day highlighted biomarkers and clinical trials. Prostate cancer is a dynamic disease and liquid biopsies of circulating tumor cells (CTC) in men with castration resistant prostate cancer (CRPC) can catch up changes and give information about prognosis and guide treatment. CTCs and circulating tumor DNA (ctDNA) levels have been found to be correlated with tumor burden, grade group and metastatic potential.

Transcriptomic classifiers are already here (for instance DECIPHER and PORTOS). There is great variability in clinical outcome in men with metastatic prostate cancer. In addition, treatment of metastatic prostate cancer is expensive. With DECIPHER, treatment can be tailored to each individual, for instance can men with a genetic profile who will benefit of treatment with docetaxel be identified. Secondary, health costs are reduced. PORTOS is a radiotherapy sensitive biomarker and high PORTOS score is associated with more adverse effects with dose-escalated radiotherapy. In salvage setting, PORTOS, can predict response to radiotherapy after biochemical recurrence. This can have a huge clinical impact to avoid overtreatment and additive adverse effects of salvage radiotherapy. The genetic marker PAM 50 can predict risk of progression for men under active surveillance for localized prostate cancer.

In imaging and pathology, artificial intelligence (AI) has the potential to increase diagnostic precision. Prostate MRI is recommended upfront in the diagnostic pathway. However, the more widespread use of prostate MRI comes with a cost and increased work-load for radiologists. In addition there is inter-reader variability between radiologists. AI-assisted interpretation could be the solution both to reduce variability and reduce work-load burden for the radiologists (there is also lack of radiologists to interpret images). Autonomous image detection, both for PET-CT and MRI, is available in the near future. In pathology, AI-assisted virtual staining is today an option and models for histological grading of the biopsies and prostatectomy specimens are developed.

The final round up of the meeting included a discussion on where we are in five years. There is no clear answers to this, but we will certainly both investigate, follow and treat prostate cancer different than today.