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 Mar 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 He emphasizes that the NCCN risk groups are outdated and asserts the need to move beyond this as a specialty.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.