**14. Summary**

The evaluation of patients who have been diagnosed with prostate adenocarcinoma is a changing paradigm, and an important one for an extremely prevalent, but often non-aggressive malignancy. Since the advent of PSA testing, patients are usually diagnosed at earlier stages, often creating the difficult questions of who needs to be treated, when, and how aggressively. As well, patient evaluation is important in the adjuvant and locally-recurrent scenarios. With increasing data on treating oligometastatic cancers, local treatment and MDT are increasingly supported by data and utilized to improve cancer endpoints. Enhanced imaging, such as PSMA PET/CT, is improving the sensitivity of detecting metastases and recurrent disease, and thereby helping in patient selection and ensuring meaningful local treatment and MDT, given the potential for toxicity.



#### **Table 5.**

*Ongoing prospective trials for validation of genomic classifiers.*

The NCCN Prostate Panel itself acknowledges that the six-tier classification system has limited predictive/prognostic value, which has been confirmed in studies, and it recommends additional studies for borderline cases. GCs have demonstrated significant prognostic value, and are undergoing increasing validation in numerous studies. As medicine increasingly progresses from personalized medicine to precision medicine, and GCs' prospective studies have an opportunity for maturation of their data, GCs will very likely have a much more significant impact on patient evaluation and ensuring the most appropriate treatment regimens.

*Radiation Therapy*
