Next Generation in Biomarkers
- More than 25 years of PSA testing has shown us its limitations. To move forward, we need to incorporate imaging (i.e. mpMRI, PET, HFUS) and biomarkers to enhance detection of curable, significant prostate cancer.
- Novel precision targets have been identified in prostate cancer through genomic sequencing efforts of both tumor and germline DNA, including many mutations that may be actionable in screening and/or therapy, and many that may have implications for unaffected family members. Efforts to streamline and standardize deep sequencing protocols with uniform reporting, reduce turn-around times, and reduce costs are critical for moving forward.
- Caregivers should give more effort towards obtaining detailed family histories in prostate cancer patients. Critical cancers that need to documented beyond prostate include the following cancers: breast, ovarian, pancreatic, melanoma, and Lynch Syndrome.
- Improving the diagnostic accuracy, evaluation, and risk stratification of bladder cancers by better determining tissue, radiographic, and molecular predictors of disease risk needs to be emphasized.
- DNA repair alterations are reasonably common and worth testing for in metastatic prostate cancer and considering for high risk localized prostate cancer. There are many pitfalls to testing, and it is important to ensure that bi-allelic loss occurs when a gene presents on a report.Overall, informatics and data management is a concern for utilizing biomarkers in GU cancers. We find there is a need for long-term local ownership and management of genetic findings to lead to the establishment of a standard of care regarding genetic testing.