Researchers presented a spatial transcriptomics–guided biomarker approach at ASCO 2026 that predicted which metastatic hormone-sensitive prostate cancer patients are most likely to benefit from adding docetaxel to androgen deprivation therapy (ADT), using only standard H&E pathology slides. The proposed signature, ST-DoxPCa, was trained using paired spatial transcriptomics and H&E data from the HEST-1K prostate cohort. The model generates a gene-based profile tied to pathways including androgen receptor signaling, oncogenesis, tumor suppression, stemness, metabolism, and inflammation. By aiming to replace genomic assays with an imaging-based strategy, the work targets scalability and affordability barriers in lower-resource settings where multiomics testing may be impractical. If validated prospectively, the approach could reshape how clinicians stratify treatment intensity in prostate cancer and broaden access to predictive testing beyond tissue destruction and cost constraints.