Figure 2.

Combining genomics and hypoxia assays to drive personalized prostate cancer medicine. Genomic signatures (DNA, RNA, epigenetic or miRNA-based) could be combined with hypoxia assays (using imaging such as positron emission tomography–fluoroazomycin arabinoside or intrinsic/extrinsic markers in situ) to triage patients with low probability of systemic metastases to local treatment alone and patients with high probability of metastases to local treatment plus systemic treatment (e.g. combined modality therapy). Systemic treatments could include those shown in Figure 1 that are currently used for metastatic disease, hypoxia-specific cytotoxins or novel agents designed to target abnormal signalling or DNA repair pathways based on susceptibility biomarkers. ADT, androgen-deprivation therapy; EBRT, external beam radiotherapy; PARP1, poly(ADP-ribose) polymerase; TIC, tumour initiating cell.