Rachel Hastings, MS, PA-C, presents “Biomarkers for Prostate Cancer.”
How to cite: Hastings, Rachel. “Biomarkers for Prostate Cancer.” Grand Rounds in Urology. Published September 22, 2025. Accessed Nov 2025. https://grandroundsinurology.com/prostate-cancer-biomarkers-screening-advanced-care/
Biomarkers for Prostate Cancer – Summary
Diane K. Newman, DNP, ANP-BC, FAAN, FAUNA, BCB-PMD, Urology and Pelvic Floor Nurse Specialist, University of Pennsylvania; Adjunct Professor of Surgery, Perelman School of Medicine, Emerita, University of Pennsylvania, Philadelphia, Pennsylvania, introduces Rachel Hastings, MS, PA-C, Urologic Oncology, New York University Langone Health, New York, New York. PA Hastings reviews the limitations of prostate-specific antigen (PSA) and magnetic resonance imaging (MRI), and outlines validated adjunctive biomarkers.
PA Hastings stresses that the goal is to avoid unnecessary biopsies while finding clinically significant prostate cancers. Biomarkers are described as complements to MRI, not replacements. For initial risk assessment, blood and urine options include prostate health index (PHI), 4KscoreⓇ, SelectMDx, and ExoDx™ Prostate. PA Hastings quickly reviews each option and provides guidelines for when each test is recommended for the patient.
For repeat biopsy considerations after an initial negative test result, tissue and urine tools include Confirm mdx, prostate cancer antigen 3 (PCA3), and Michigan Prostate Score (MiPS). Considering cost, access, and patient preference, these should be ordered only when results could influence management.
Genomic assays, including ProlarisⓇ, Oncotype DX Genomic Prostate ScoreⓇ, and DecipherⓇ Prostate, are reviewed for active surveillance or favorable intermediate-risk disease. These tissue-based tests estimate the risk of adverse pathology, metastasis, and cancer-specific mortality. ArteraAI is highlighted as a newer platform analyzing multiple biopsy cores to predict the benefit from androgen deprivation therapy (ADT) intensification with radiation.
Prostate-specific membrane antigen positron emission tomography (PSMA PET) is used for high-risk disease and biochemical recurrence, with warnings regarding detection rates at low PSA levels and potential false positives. In patients with advanced disease, circulating tumor cell assays, AR-V7 resistance marker testing, and germline testing are all tools that aid treatment decisions.
