From the Guidelines
Molecular biomarkers play a crucial role in the diagnosis and treatment of prostate cancer, particularly in identifying clinically significant disease and guiding treatment decisions, as evidenced by the use of commercially available biopsy-based multigene expression classifiers such as Decipher, Oncotype Dx Prostate, and Prolaris 1. The role of molecular biomarkers in prostate cancer is multifaceted, including:
- Diagnosis: Molecular biomarkers can help diagnose clinically significant prostate cancer, which is essential for determining the best course of treatment.
- Prognosis: These biomarkers can provide additional prognostic value, contributing to risk stratification and patient counseling when added to standard clinical parameters.
- Treatment selection: Molecular biomarkers can inform treatment decisions, such as whether to add androgen-deprivation therapy to radiation therapy in select unfavorable intermediate-risk patients. Some of the molecular biomarkers used in prostate cancer include:
- Biopsy-based multigene expression classifiers (e.g., Decipher, Oncotype Dx Prostate, and Prolaris)
- Protein-based biomarkers (e.g., ProMark) These biomarkers can improve clinical decision-making and personalize prostate cancer management, although their ability to improve outcomes (quality of life and risk of metastasis or death) has not been prospectively evaluated 1. In clinical practice, molecular biomarkers can be considered in specific scenarios, such as:
- Select unfavorable intermediate-risk patients when deciding whether to add androgen-deprivation therapy to radiation therapy
- Patients considering active surveillance, where additional prognostic value can inform treatment decisions 1.
From the Research
Role of Molecular Biomarkers in Prostate Cancer
- Molecular biomarkers, such as PCA3 and TMPRSS2-ERG gene fusion, have been identified as potential diagnostic tools for prostate cancer 2, 3, 4, 5, 6
- These biomarkers have shown increased specificity in prostate cancer detection compared to traditional prostate-specific antigen (PSA) testing 2, 4, 6
- The combination of PCA3 and TMPRSS2-ERG gene fusion testing has been shown to optimize prostate cancer detection and reduce the number of unnecessary biopsies 2, 3, 6
Diagnostic Significance of PCA3 and TMPRSS2-ERG
- PCA3 is a non-coding RNA that is highly expressed in prostate cancer cells and has been identified as a promising biomarker for clinical diagnosis and targeted therapy 2, 4, 5
- TMPRSS2-ERG gene fusion is a genetic change that is specific to prostate cancer and has been shown to be a useful diagnostic biomarker 2, 3, 4, 5, 6
- The sensitivity of PCA3 and TMPRSS2-ERG in detecting prostate cancer has been reported to be 76.9% and 92.3%, respectively 5
Clinical Implications and Performance
- The use of PCA3 and TMPRSS2-ERG gene fusion as diagnostic biomarkers has the potential to improve the accuracy of prostate cancer diagnosis and reduce the number of unnecessary biopsies 2, 3, 4, 6
- Further research is needed to fully understand the clinical implications and performance of these biomarkers in prostate cancer diagnosis 2, 3, 4