• Michael Misialek, MD

A Precision Medicine Approach to Prostate Cancer

Pathologists play a critical role in the selection and maintenance of prostate cancer patients on active surveillance (AS) protocols. In order to guide the utility of AS, effective biomarkers need to be developed and tested. According to a recent paper in the Archives of Pathology and Laboratory Medicine, the field of biomarker research for AS stratification would benefit greatly from:

(1) the qualification of existing biomarkers for use in AS stratification and prioritization for testing

(2) multi-institutional, ‘‘prospective-retrospective’’ clinical trials with archived tissue and DRE urine for new biomarker discovery

(3) prospective clinical trials for validation of biomarkers from retrospective biomarker studies

(4) multi-institutional, prospective trials with tissue, blood, and DRE urine collections.

These biomarkers will help assess the aggressiveness of the tumor and decide whether or not treatment is indicated. New diagnostic techniques are available which can yield additional information and can help in the decision of whether to perform a tissue biopsy. The Prostate Health Index (PHI) test is a combination of three forms of the PSA protein. The results are used to provide a probability of cancer. The 4K score is a blood test measuring 4 different prostate related proteins that provides a percent risk score of having an aggressive prostate cancer. Another test is the Prostate Cancer Gene 3 test (PCA3) which is a gene based test carried out on urine. The higher the level, the more likely the chance cancer is present.

Different types of genetic testing may be performed to give information on the tumor’s growth rate, aggressiveness and risk of morbidity. Such tests include Prolaris, OncotypeDX and ProstaVysion.

A precision medicine approach to prostate cancer will be increasingly utilized. The role of pathologists has never been more important. Make sure a pathologist is on your team.

#psa #prostatecancer #biomarkers #pathology #biopsy

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