Genetic testing for the clinician in prostate cancer

ABSTRACT

Introduction

Prostate cancer (PCa) is one of the most common cancers worldwide and a leading cause of cancer-related mortality. Although the diagnosis and treatment of prostate cancer has improved substantially in recent years, new molecular biomarkers are needed to further prolong survival and improve the quality of life in these patients.

Areas covered

This review analyzes the current evidence for prognostic and predictive molecular biomarkers that can be applied across different clinical scenarios, ranging from localized disease to metastatic castration-resistant PCa, with a particular emphasis on the biomarkers likely to become available in routine clinical practice in the near future.

Expert opinion

There is a growing need for molecular testing to identify the most indolent types of prostate cancer to help optimize treatment strategies and spare treatment in these patients when possible. Current trends in the treatment of prostate cancer underscore the unmet clinical need for biomarkers to improve decision-making in a challenging clinical setting.

KEYWORDS:

• Biomarkers
• gene panels
• genetic counseling
• genetic testing
• germline mutation

Article highlights

• New biomarkers are needed to optimize the diagnosis of prostate cancer (PCa) to reduce unnecessary biopsies.

• A wide range of serum and urinary markers are available for PCa diagnosis, but there is a lack of data on which are the most useful. We expect the association between imaging and biomarkers will improve the precision of PCa diagnostics.

• In localized PCa, genomic classifiers provide additional information to complement clinical and radiological parameters to stratify patients into risk groups.

• Genomic classifiers could help to guide treatment selection, but their clinical impact on treatment outcomes remains unknown.

• Numerous clinical trials are currently in advanced stages of development, especially those investigating genetic alterations in DNA repair mechanisms. The results of those trials will determine the future treatment approach to advanced PCa.

• In advanced PCa, major progress has been made in the field of liquid biopsy, although many of these tests must be validated before they can be incorporated into routine clinical practice.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.