3rd Annual Jefferson Urology Symposium: Men’s Health Forum

© The Canadian Journal of Urology TM : International Supplement, August 2020 An overview of biomarkers in the diagnosis and management of prostate cancer Alex Uhr, MD, Lydia Glick, BS, Leonard G. Gomella, MD Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA UHR A, GLICK L, GOMELLA LG. An overview of biomarkers in the diagnosis and management of prostate cancer. Can J Urol 2020;27(Suppl 3):24-27. Introduction: Prostate cancer is a common malignancy with highly variable clinical presentation and outcomes. Diagnosis and management remain a challenge and at times become highly controversial. Novel biomarker assays have shown promise as an adjunctive tool to aid in patient shared decision-making, risk stratification, and disease management. This presentation at the 2020 JeffersonUrology Symposium provided a review of current commonly used biomarkers for prostate cancer. Materials and methods: We reviewed the current literature on the use of biomarkers in the diagnosis and treatment decisions in localized prostate cancer. Results: Biomarker assays were reviewed and presented according to clinical application of each test. In the consideration of initial prostate biopsy the blood tests for PHI, and 4K Score, and urine tests PCA3, Select MDx and ExoDx are available. In the consideration of treatment versus active surveillance in the biopsy positive setting OncotypeDx, Prolaris and Decipher are available. In patients with an initial negative biopsy, 4K score, PCA3, ExoDx and the tissue biopsy based Confirm MDx assay can help guide the decision to perform repeat biopsy. In the consideration for adjuvant radiation following radical prostatectomy the most extensive literature available supports the use of Prolaris or Decipher tissue assays. Conclusions: With the significant burden of men being diagnosed with prostate cancer, it is desirable to appropriately risk stratify patients to avoid unnecessary biopsies and over-treatment in low risk patients and guide appropriate treatment strategies in high risk patients. Selected biomarkers presented are useful adjunctive precision medicine tools to aid in shared decision making and to direct treatment decisions. Key Words: prostate cancer, biomarkers, genomics, precision medicine, active surveillance Address correspondence to Dr. Leonard G. Gomella, Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, Suite 1100, Philadelphia, PA 19107 USA Introduction Prostate cancer is the secondmost common solid tumor cancer and the most frequent urologic malignancy in men worldwide. In 2020 it is estimated that in the United States 191,000 men will be diagnosed and approximately 33,000 men will die from the disease. It accounted for 26% of all new cancer cases in men in the United Kingdom in 2017. 1,2 The application of prostate-specific antigen (PSA) based screening has led to an increase in men undergoing prostate biopsy and has provided the opportunity for early cancer diagnoses with the risk of unnecessary biopsy resulting in over diagnosis of clinically unimportant disease. 3,4 With the widespreadprevalence of prostate cancer, it is important to distinguish between patients with clinically 24 significant cancers that require treatment and thosewho may be candidates for less aggressive active surveillance and avoid unnecessary treatment. While men with higher Gleason scores have been shown to have higher mortality rates, men with low risk disease have about a 3%mortality rate at 15 years after diagnosis. In patients with low risk disease who have a non-aggressive cancer, there is potential for over-treatment, often with significant, life altering side effects. 5,6 In patients who underwent radical prostatectomy, it has been reported in the literature that up to 90% of patients experienced some degree of erectile dysfunction andmore than 50% reported incontinence. 7 Because of the heterogenous nature of prostate cancer, correctly identifying patients through precision medicine strategies who may be at risk for aggressive disease as well as those with indolent disease in order to guide the best management is essential. Current clinical tools used to manage prostate cancer typically includes PSAlevels, digital rectal exam (DRE) abnormalities, imaging data, age coupled with