Open Access

Simon K. B. Spohn, Cédric Draulans, Amar U. Kishan, Daniel Spratt, Ashley Ross, Tobias Maurer, Derya Tilki, Alejandro Berlin, Pierre Blanchard, Sean Collins, Peter Bronsert, Ronald Chen, Alan Dal Pra, Gert de Meerleer, Thomas Eade, Karin Haustermans, Tobias Hölscher, Stefan Höcht, Pirus Ghadjar, Elai Davicioni, Matthias M. Heck, Linda G. W. Kerkmeijer, Simon Kirste, Nikolaos Tselis, Phuoc T. Tran, Michael Pinkawa, Pascal Pommier, Constantinos Deltas, Nina-Sophie Schmidt-Hegemann, Thomas Wiegel, Thomas Zilli, Alison C. Tree, Xuefeng Qiu, Vedang Murthy, Jonathan I. Epstein, Christian Graztke, Xin Gao, Anca L. Grosu, Sophia C. Kamran, Constantinos Zamboglou

• Background: Current risk-stratification systems for prostate cancer (PCa) do not sufficiently reflect the disease heterogeneity. Genomic classifiers (GC) enable improved risk-stratification after surgery, but less data exists for patients treated with definitive radiotherapy (RT) or RT in oligo-/metastatic disease stages. In order to guide future perspectives of GCs for RT, we conducted (i) a systematic review on the evidence of GCs for patients treated with RT and (ii) a survey of experts using the DELPHI method, addressing the role of GCs in personalized treatments to identify relevant fields of future clinical and translational research. Methods: We performed a systematic review and screened ongoing clinical trials on “clinicaltrials.gov”. Based on these results a multidisciplinary international team of experts received an adapted DELPHI method survey. 31 and 30 experts answered round 1 and round 2, respectively. Questions with ≥ 75% agreement were considered as relevant andBackground: Current risk-stratification systems for prostate cancer (PCa) do not sufficiently reflect the disease heterogeneity. Genomic classifiers (GC) enable improved risk-stratification after surgery, but less data exists for patients treated with definitive radiotherapy (RT) or RT in oligo-/metastatic disease stages. In order to guide future perspectives of GCs for RT, we conducted (i) a systematic review on the evidence of GCs for patients treated with RT and (ii) a survey of experts using the DELPHI method, addressing the role of GCs in personalized treatments to identify relevant fields of future clinical and translational research. Methods: We performed a systematic review and screened ongoing clinical trials on “clinicaltrials.gov”. Based on these results a multidisciplinary international team of experts received an adapted DELPHI method survey. 31 and 30 experts answered round 1 and round 2, respectively. Questions with ≥ 75% agreement were considered as relevant and included into the qualitative synthesis. Results: Evidence for GCs as predictive biomarkers is mainly available to the postoperative RT setting. Validation of GCs as prognostic markers in the definitive RT settings is emerging. Experts used GCs in PCa patients with extensive metastases (30%), in postoperative settings (27%) and newly diagnosed PCa (23%). 47% of experts do not currently use GCs in clinical practice. Expert consensus demonstrates that GCs are promising tools to improve risk-stratification in primary and oligo-/metastatic patients in addition to existing classifications. Experts were convinced that GCs might guide treatment decisions in terms of RT-field definition and intensification/de-intensification in various disease stages. Conclusions: This work confirms the value of GCs and the promising evidence of GC utility in the setting of RT. Additional studies of GCs as prognostic biomarkers are anticipated and form the basis for future studies addressing predictive capabilities of GCs to optimize RT and systemic therapy. The expert consensus points out future directions for GC research in the management of PCa.…