New results from the BALANCE trial, presented at the American Society for Radiation Oncology (ASTRO) 2025 meeting, highlight the PAM50 molecular signature as a diagnostic tool to help identify which men with recurrent prostate cancer benefit from hormone therapy alongside salvage radiation.
The trial enrolled 295 men whose cancer returned after prostate surgery. Patients were randomly assigned to receive salvage radiation with either apalutamide or a placebo for six months.
Researchers used the PAM50 biomarker to sort patients into luminal B and non-luminal B tumor groups. After a median follow-up of five years, men with luminal B tumors responded better to hormone therapy: 72 percent remained free of biochemical failure (PSA rise) with apalutamide, compared with 54 percent in the placebo group. In non-luminal B tumors, results were nearly identical regardless of treatment (70 percent vs 71 percent).
This marks the first prospective, randomized validation of a predictive biomarker in non-metastatic prostate cancer. By incorporating biomarkers such as PAM50 into clinical workflows, diagnostic laboratories can help provide physicians with additional data to support treatment planning. These findings contribute to an expanding body of evidence demonstrating the utility of genomic classifiers in improving precision across oncology diagnostics.
The PAM50 test is currently available for research use through Veracyte’s Decipher GRID platform. It joins other transcriptome-based assays under study for predicting treatment response in prostate cancer. The Decipher Prostate test, already included in NCCN guidelines, is being evaluated in related trials such as PREDICT-RT.
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