Matthew R. Cooperberg, MD, MPH, presented “Updates in Prostate Cancer Biomarkers” during the 32nd Annual International Prostate Cancer Update (IPCU32) conference on March 8, 2022, in Snowbird, Utah.
How to cite: Cooperberg, Matthew R. “Updates in Prostate Cancer Biomarkers” March 8, 2022. Accessed Nov 2024. https://grandroundsinurology.com/updates-in-prostate-cancer-biomarkers/
Updates in Prostate Cancer Biomarkers – Summary
Matthew R. Cooperberg, MD, MPH, Professor of Urology and Epidemiology & Biostatistics and Helen Diller Family Chair in Urology at the University of California, San Francisco, begins his discussion with the assertion that prostate-specific antigen (PSA) testing is not going away anytime soon and displays a chart illustrating the distribution of total PSA (ng/ml) by age group and race among controls from case-control studies of prostate cancer. He explains that a PSA below the median has a very strong negative predictive value (NPV) in terms of meaningful cancer. He asserts that, when combined with secondary biomarker testing before biopsy, early baseline PSA can be very effective in terms of risk assessment. Dr. Cooperberg poses the question, “how do we screen smarter?” and addresses a new PSA protocol being implemented across the primary care network at the University of California, San Francisco (UCSF), whereby PSA is checked/rechecked or patients are referred for further biomarker testing based upon various baseline PSA thresholds. Dr. Cooperberg moves to post-diagnosis and discusses updated National Comprehensive Cancer Network (NCCN) guidelines that say active surveillance (AS) is preferred for most patients and encourages consideration of a confirmatory multiparametric magnetic resonance imaging (mpMRI) +/- prostate biopsy and/or molecular tumor analysis if MRI is not performed initially. He emphasizes that the NCCN risk groups are outdated and asserts the need to move beyond this as a specialty. He takes a deeper dive into what low-risk cancer actually looks like genomically and asserts that urologists need to be looking at the variations in the genomic nature of these tumors. He then asserts that the field is getting closer to identifying predictive markers and cites a matched, retrospective analysis of the development and validation of a 24-gene predictor of response to postoperative radiotherapy in prostate cancer and another study that looked at ADT treatment response following radical prostatectomy. Dr. Cooperberg explains the field is evolving toward the ability to use genomic information derived from the primary tumor to make initial and follow-on treatment decisions. He addresses health literacy then turns to a multivariable model based on clinical information that he asserts can stratify men quite accurately in terms of AS on a five-year time horizon. Dr. Cooperberg explains that the answer to where the markers fit is still evolving, citing the first prospective, randomized trial assessing molecular classifier utility in prostate cancer and explaining that other studies are ongoing.
About the 32nd Annual International Prostate Cancer Update (IPCU32):
Presented by Program Chair E. David Crawford, MD, The International Prostate Cancer Update (IPCU), is a multi-day, CME-accredited conference focused on new developments in prostate cancer treatment, diagnosis, and prevention. IPCU 32 featured lectures, interactive discussions, panel roundtables, debates, and case reports. This conference was led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer.
ABOUT THE AUTHOR
Matthew R. Cooperberg, MD, MPH, is Professor of Urology and Epidemiology & Biostatistics and Helen Diller Family Chair in Urology at the University of California, San Francisco. He earned an undergraduate degree in English from Dartmouth College in Hanover, New Hampshire, before pursuing his MD from the Yale School of Medicine in New Haven, Connecticut. Dr. Cooperberg also earned an MPH with a concentration in Health Policy from the Yale School of Epidemiology and Public Health. He joined the faculty at UCSF in 2009, and was named a professor there in 2018.
Dr. Cooperberg’s clinical interests include the diagnosis and management of genitourinary malignancies, as well as minimally-invasive techniques to treat benign and malignant diseases. His research focus is prostate cancer, and in this area he is particularly interested in health services, risk assessment and biomarkers, comparative effectiveness of treatments, and decision support and survivorship. He is also interested in care disparities and in looking at prostate cancer as an international disease.
Dr. Cooperberg has written over 400 peer-reviewed scientific articles and is an investigator on several ongoing federal grants. He has won the Young Investigator Award from the Prostate Cancer Foundation and the American Urological Association Gold Cystoscope Award, and was also named Young Urologist of the Year in 2015. He is a Fellow of the American College of Surgeons and a member of the American Urological Association and the Society for Urologic Oncology.
