Follow-up Biomarker Testing in Prostate Cancer

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In prostate cancer, there has been a paradigm shift around not only whom to biopsy but also around the utilization of both positive and negative results. Diagnoses is no longer based solely on one biopsy alone, and a negative biopsy may not be dismissed as normal, especially if accompanied by other signs and risk factors of prostate cancer.

Christopher Pieczonka, MD, describes some of available “follow-up” tests that may be appropriate: The Prostate Core Mitomic Test, ConfirmMDx, ProMark, TMPRSS2-ERG gene fusion assay, and PTEN mutation testing.

The Prostate Core Mitomic Test is a relatively new, highly accurate, and painless way to identify patients at risk of having a tumor missed by a prostate biopsy procedure and to reassure those who are at a very low risk of having a missed tumor. The ConfirmMDx test examines methylation, a marker for aggressiveness that can provide an important piece of information for determining treatment and ProMark is the first available proteomic-based imaging test, which can be used to differentiate between favorable and unfavorable pathology.

Genetic alterations in specific genes and gene fusions should also be examined, explains Pieczonka. The TMPRSS2-ERG gene fusion, a transmembrane protease, is a marker of overall cell growth and PTEN mutation status continues to be a useful strategy. While PTEN mutation cannot predict the prognosis, PTEN mutation—positives status has been associated with poorer prognosis and a higher rate of metastasis.

At this time, many of these tests still need to be validated within various patient cohorts. It will take time to determine for whom and at what point in the diagnosis and disease process these and other available tests are appropriate to utilize.