fig2

Figure 2. A model for clinical trials of prognostic biomarkers in localized, non-indolent prostate cancer. All patients newly diagnosed with localized prostate cancer receive a test to establish risks of disease relapse following local therapy, in addition to traditional stratification based on existing clinical prognostic factors. Patients whose test suggests a low likelihood of adverse clinical outcome receive standard of care therapy (i.e., precision radiotherapy or surgery). Patients whose test suggests a likelihood of disease relapse significantly higher than expected from clinical prognostic factors are randomized to standard of care or standard of care plus intensification, which may include (neo) adjuvant androgen deprivation (ADT), chemotherapy, or molecular targeted agents