As proof of concept, escalated therapy has been associated with improved outcomes in very high-risk patients, eg, combination EBRT plus BT and ADT in men with Gleason score 9 to 10 prostate cancer23 and use of longer ADT durations in higher-grade disease.24 It is logical to consider ways of intensifying therapy (eg, advanced ADT as in the Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy trial)25 for patients with high PSMA nomogram risk, but prospective validation is required. This evidence concerns the gene FOLH1 and prostate carcinoma.