Molecular testing may soon be able to significantly lower morbidity and mortality in men diagnosed with prostate cancer, according to urologic oncologist Ashley Ross, MD, PhD, who is a pathologist and an assistant professor of urology at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD. He presented a talk titled, “Multigene Testing in Prostate Cancer Risk Stratification” at the National Comprehensive Cancer Network (NCCN) 21st Annual Conference: Advancing the Standard of Cancer Care.1
He said a greater molecular understanding of prostate cancer is increasing exponentially.
“Molecular tests for prostate cancer have been developed that add independent prognostic information across NCCN risk categories for localized prostate cancer. These tests may better inform management of patients with prostate cancer, including those considering active surveillance or treatment as well as those considering adjuvant and salvage therapies,” Dr Ross told Cancer Therapy Advisor.
He said evidence suggests that the current generation of tests are prognostic, and selective use of these tests may be beneficial. However, he added that the tests must be put into context of current practice. Clinicians must also factor results from multiparametric magnetic resonance imaging (mpoMRI)/fusion biopsy, PHI/PCA3/4K score, and the use of nomograms for decision-making.
Dr Ross noted that head-to-head comparisons are needed to inform providers about which molecular tests may be the most beneficial in men with high-risk and low-risk disease. The largest impact from the newest generation of molecular tests may come in areas of greatest decision uncertainty. He said these types of tests may be predictive and may help better guide clinicians when it comes to radical prostatectomy versus radiotherapy (RT), RT +/- androgen-deprivation therapy and early use of docetaxel.
“The use of molecular tests such as Prolaris, Decipher, and Oncotype DX prostate cancer test can be immediately adopted to help with risk stratification. In most cases, however, these tests will be confirmatory and only in the minority of men will the tests likely alter clinical practice,” Dr Ross told Cancer Therapy Advisor. “Currently, tests are being developed that could be predictive of treatment response. These tests need further verification but could have a large impact.”
He noted that clinicians now have an increased ability to obtain molecular information from routinely collected and stored formalin-fixed paraffin embedded tissue. He said that some companies are aggressively marketing specific molecular tests for prostate cancer, but there is a lack of head-to-head comparisons among different molecular testing products, which has led to some confusion among patients and clinicians.