About

Thomas James Polascik is the Lawrence C. Katz Distinguished Professor of Urology at Duke University. He holds multiple titles including Professor of Urology and Professor in Radiology, and is a member of the Duke Cancer Institute. His professional roles are based at Duke South DUMC in Durham, North Carolina. Dr. Polascik is involved in urology education and training, including residency programs and urologic oncology fellowships, with a focus on minimally invasive technologies for the management and diagnosis of prostate and kidney cancer. His work emphasizes advancing urologic oncology through research and clinical practice, contributing to the academic and medical community at Duke University.

Research topics

• Medicine
• Internal medicine
• Artificial Intelligence
• Radiology
• Computer Science
• Family medicine
• Medical physics
• Surgery
• Urology
• Algorithm
• Nuclear medicine
• Statistics
• Genetics
• Nursing
• Gynecology
• Pathology

Selected publications

• IP53-03 UTILIZING REVERSE-FUSION ANALYSIS AND IMAGING RE-REVIEW TO RECONCILE IMAGING-PATHOLOGY DISCORDANCE IN HISTOLOGICALLY NEGATIVE TARGETED BIOPSY OF PI-RADS 5 LESIONS

  The Journal of Urology · 2026-04-27

  article
  PublisherDOI

• IP37-19 IMPACT OF IRREVERSIBLE ELECTROPORATION ON SEXUAL FUNCTION: AN ANALYSIS OF THE PRESERVE TRIAL

  The Journal of Urology · 2026-04-27

  article
  PublisherDOI

• Correction to: Imaging and Focal Therapy of Early Prostate Cancer

  2025-01-01

  book-chapterOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Survival benefit associated with first-line androgen receptor pathway inhibitors for de novo metastatic castration-sensitive prostate cancer

  Prostate Cancer and Prostatic Diseases · 2025-07-24 · 4 citations

  articleOpen accessSenior author

  BACKGROUND: Limited real-world data exist on the effectiveness of treatment intensification (TI) with androgen receptor pathway inhibitors (ARPI) in de novo metastatic castration-sensitive prostate cancer (mCSPC). This study compared outcomes of TI or first-generation nonsteroidal antiandrogens (NSAAs) to androgen-deprivation therapy (ADT) alone in US patients with de novo mCSPC. METHODS: Veterans Affairs patients with de novo mCSPC (February 2018-June 2020) confirmed via chart review were grouped into ADT alone, ADT + NSAAs, or ADT + ARPI cohorts using predefined recruitment quotas. Outcomes included inverse probability of treatment weighting (IPTW)-adjusted overall survival (OS), progression to metastatic castration-resistant prostate cancer (mCRPC), and prostate-specific antigen (PSA) response. RESULTS: A total of 384 patients were identified (ADT alone: 163, ADT + NSAA: 101, ADT + ARPI: 120). Median follow-up was 37.2, 38.1, and 34.8 months for ADT alone, ADT + NSAA, and ADT + ARPI, respectively. Compared with ADT alone, ADT + ARPI showed significantly better OS (HR [95% CI]: 0.61 [0.43 to 0.87], p = 0.007), lower risk of progression to mCRPC (0.46 [0.33 to 0.66], p < 0.001), and higher PSA response rate (PSA decline of ≥50% and ≥90% from baseline, and to <0.2 ng/mL and <0.1 ng/mL any time during first-line treatment; all p < 0.05). Outcomes with ADT + NSAA did not differ from ADT alone. ADT + ARPI was the most common second-line mCSPC and first-line mCRPC treatment. CONCLUSIONS: First-line ADT + ARPI was associated with significantly improved outcomes vs ADT alone in de novo mCSPC. These real-world results align with the benefits demonstrated in trials, supporting integration of TI with ARPIs into clinical practice to improve survival outcomes in patients with de novo mCSPC.

  PublisherOA PDFDOI

• Comparative Economic Evaluation of Radical Prostatectomy, Radiation, and Ablative Techniques in the Management of Localized Prostate Cancer

  Preprints.org · 2025-08-18

  preprintOpen accessSenior author

  Background: To compare the costs of open retropubic radical prostatectomy (RRP), robotic-assisted radical prostatectomy (RALP), intensity-modulated radiation therapy (IMRT), low-dose brachytherapy (LDBT), stereotactic body radiotherapy (SBRT), cryotherapy (Cryo), and high-intensity focused ultrasound (HIFU) for low/intermediate-risk prostate cancer (PCa), from the healthcare system perspective. Methods: This retrospective, IRB-approved study compared the costs and charges of primary treatment options for localized PCa at Duke University Hospital between January 2018 and December 2019. Case identification was carried out by querying the relevant disease, procedural, and charge codes from Duke Finance. Consecutive cases with NCCN high-risk disease, prior treatment, or missing institutional financial information were excluded. Costs were calculated from the point at which the treatment option was selected until the last treatment session (SBRT and IMRT) or hospital discharge (other modalities). All modalities except RRP were considered technology-intensive. Results: A total of 552 patients with a mean age of 65.0 years met the inclusion criteria. NCCN risk categories included 85 (13%) low, 218 (41%) favorable-intermediate, and 249 (46%) unfavorable-intermediate risk cases. RALP, RRP, Cryo, and HIFU were single-session treatments, whereas IMRT, SBRT, and LDBT were delivered over multiple sessions. IMRT and SBRT were the most expensive modalities, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of sessions (ρ=0.55, p&amp;amp;lt;0.001) and being technology-intensive (ρ=0.58, p&amp;amp;lt;0.001) were significantly correlated with treatment costs. Conclusions: In this cohort of PCa patients, treatment costs were highest for IMRT and SBRT, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of treatment sessions significantly correlated with increased costs.

  PublisherOA PDFDOI

• Comparative Economic Evaluation of Radical Prostatectomy, Radiation, and Ablative Techniques in the Management of Localized Prostate Cancer

  Cancers · 2025-08-28

  articleOpen accessSenior author

  Background: To compare the costs of open retropubic radical prostatectomy (RRP), robotic-assisted radical prostatectomy (RALP), intensity-modulated radiation therapy (IMRT), low-dose brachytherapy (LDBT), stereotactic body radiotherapy (SBRT), cryotherapy (Cryo), and high-intensity focused ultrasound (HIFU) for low/intermediate-risk prostate cancer (PCa), from the healthcare system perspective. Methods: This retrospective, IRB-approved study compared the costs and charges of primary treatment options for localized PCa at Duke University Hospital between January 2018 and December 2019. We identified cases by querying the relevant disease, procedural, and charge codes from Duke Finance. Consecutive cases with NCCN high-risk disease, prior treatment, or missing institutional financial information were excluded. Costs were calculated from the point at which the treatment option was selected until the last treatment session (SBRT and IMRT) or hospital discharge (other modalities). All modalities except RRP were considered technology-intensive. Results: A total of 552 patients with a mean age of 65.0 years met the inclusion criteria. NCCN risk categories included 85 (13%) low, 218 (41%) favorable-intermediate, and 249 (46%) unfavorable-intermediate risk cases. RALP, RRP, Cryo, and HIFU were single-session treatments, whereas IMRT, SBRT, and LDBT were delivered over multiple sessions. IMRT and SBRT were the most expensive modalities, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of sessions (ρ = 0.55, p &lt; 0.001) and being technology-intensive (ρ = 0.58, p &lt; 0.001) were significantly correlated with treatment costs. Conclusions: In this cohort of PCa patients, treatment costs were highest for IMRT and SBRT, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of treatment sessions was a significant predictor of higher costs.

  PublisherOA PDFDOI

• Genetic ancestry concordant RNA splicing in prostate cancer involves oncogenic genes and associates with recurrence

  npj Precision Oncology · 2025-01-29 · 2 citations

  articleOpen access

  Black men suffer disproportionately from prostate cancer (PCa) compared to men of other races and ethnicities. Comparing the molecular landscape of PCa among Black and White patients has the potential to identify targets for development of new precision medicine interventions. Herein, we conducted transcriptomic analysis of prostate tumors and paired tumor-adjacent normals from self-reported Black and White PCa patients and estimated patient genetic ancestry. Clinical follow-up revealed increased biochemical recurrence (BCR) among Black patients compared to White patients with high-grade PCa. Transcriptomic analysis identified differential alternative RNA splicing events (ARSs) between Black and White PCa patients. Genes undergoing genetic ancestry-concordant ARSs in high-grade or low-grade tumors involved cancer promoting genes. Most genes undergoing genetic ancestry-concordant ARSs did not exhibit differential aggregate gene expression or alternative polyadenylation. A number of the genetic ancestry-concordant ARSs associated with BCR; thus, genetic ancestry-concordant RNA splice variants may represent unique targets for PCa precision oncology.

  PublisherOA PDFDOI

• Re: Alec Zhu, Mary O. Strasser, Timothy D. McClure, et al. Comparative Effectiveness of Partial Gland Cryoablation Versus Robotic Radical Prostatectomy for Cancer Control. Eur Urol Focus 2024;10:843–50

  European Urology Focus · 2025-01-31

  letterSenior author
  PublisherDOI

• Transcriptomic predictors of prostate cancer recurrence following focal cryotherapy: a pooled analysis of phase II trial and prospective cohort data

  Journal of the National Cancer Center · 2025-05-28

  articleOpen access

  Focal therapy (FT) is a potential treatment option for limited-volume clinically-significant prostate cancer (csPCa). However, despite rigorous selection, approximately 20% of patients experience early failure. We investigated the association of transcriptomic profiles and csPCa recurrence post-FT. 52 men from a phase II trial (NCT04138914) and a prospective observational cohort underwent focal cryotherapy for csPCa. Patients underwent multiparametric magnetic resonance imaging, and targeted and systematic-saturation biopsy before- and 1-year post-FT. Recurrence was defined as grade-group (GG) ≥2 cancer in the 1-year post-FT biopsy. Pre-treatment lesions were profiled using the Decipher genomic classifier (GC). GC scores, luminal-basal status, tumor microenvironment and cancer hallmark pathways were correlated with csPCa recurrence. Median PSA was 7.0 ng/dl; 37/52(71.1%) men had GG2, 12/52(23.1%) GG3, and 3/52(5.8%) GG4 cancer. Recurrence was observed in 9/52 (17.3%) men. Median GC score was higher in patients with recurrence (0.60 vs 0.38, P = 0.014) and remained significantly associated with recurrence after adjustment for GG (Adjusted OR : 1.37 [95% CI: 1.01–1.93], P = 0.04). Luminal-proliferative tumors based on the prostate cancer-specific subtyping classifier (PSC) had more csPCa recurrence compared with luminal-differentiated (LD) and basal subtypes (30.4% vs 0% [LD] vs 15.4% [basal-neuroendocrine] and 14.3% [basal-immune], P = 0.027). Higher expression of DNA repair pathway was also associated with recurrence ( OR : 2.12 [95% CI: 1.09–4.57], P = 0.025). Higher GC score is associated with risk of csPCa recurrence post-FT. Patients with GC low-risk and PSC-LD csPCa may represent the ideal subgroup for FT. Prospective validation in a large cohort is warranted.

  PublisherDOI

• MP04-17 COMPLETE CLINICAL TRIALS OF GOLD NANOSHELLS BASED THERAPY FOR LOCALIZED PROSTATE CANCER ABLATION TREATMENT - MULTIPLE INVESTIGATIONAL CLINICAL SITES

  The Journal of Urology · 2025-04-08 · 1 citations

  article
  PublisherDOI

Frequent coauthors

• Vladimir Mouraviev

  164 shared

• Matvey Tsivian

  Atrium Health Wake Forest Baptist

  158 shared

• Judd W. Moul

  Duke University

  145 shared

• Stephen J. Freedland

  Durham VA Medical Center

  108 shared

• Cary N. Robertson

  94 shared

• Kae Jack Tay

  Singapore General Hospital

  94 shared

• Rajan T. Gupta

  81 shared

• Ariel Schulman

  Maimonides Medical Center

  74 shared

Labs

• The Thomas Polascik, MD, Research LaboratoryPI