Biomarkers in Prostate Cancer: Testing the Right Patients, Reading the Right Report

In this OncLive News Network program, genitourinary oncology experts examine how biomarker testing has become central to treatment selection in prostate cancer now that biomarker-defined therapies apply at the onset of metastatic hormone-sensitive disease. The panelists distinguish actionable findings, such as BRCA1/2 and other homologous recombination repair (HRR) alterations, mismatch repair deficiency, and PTEN loss by immunohistochemistry, from prognostic alterations that lack a matched therapy. They recommend germline and somatic testing for every patient with metastatic disease, clarify the role of RNA-based genomic classifiers in localized disease, and compare tissue sequencing with circulating tumor DNA, highlighting the risk of missed deletions and clonal hematopoiesis. The discussion covers when to retest as tumors evolve, how to interpret prostate-specific membrane antigen PET for radioligand therapy selection and response assessment, and how to judge non-BRCA HRR alterations in light of TALAPRO-3. The program closes with emerging cell surface targets and neuroendocrine biomarkers poised to reshape practice.