Urologists Discuss Their Use of Biomarker Tests in Considering Active Surveillance

Beth Fand Incollingo @fandincollingo
Published: Friday, Sep 12, 2014
Dr. Raoul Concepcion

Raoul S. Concepcion, MD

Editor-in-Chief of
Urologists in Cancer Care

Director of Clinical Research
Urologic Surgeon
Urology Associates, PC
Nashville, TN

When an otherwise healthy man has a biopsy that is positive for prostate cancer, it’s not unusual for him to be opposed to treatment, telling his urologist that, based on what he’s read, no one dies of the disease.

On the other hand, another man in the same situation is just as likely to insist that his prostate be removed—yesterday, if possible.

Neal Shore, MD, medical director of Carolina Urologic Research Center and a partner with Atlantic Urology Clinics, in South Carolina, has heard these comments from patients time and again, and he knows that they stem from a lack of information.

Luckily, due to a growing understanding of biomarkers for disease severity and progression in prostate cancer, urologists have more opportunities than ever to gather the information their patients need to make informed treatment decisions, Shore and a group of colleagues said during a May peer exchange panel discussion hosted by OncLive TV.

A battery of new tests that recognize biomarkers in urine, blood, or prostate tissue can help urologists determine who needs an initial biopsy; who, after a negative biopsy, needs a rebiopsy; which patients, after a positive biopsy, have a higher risk of progression or mortality; and how individual patients being treated with various therapies are likely to respond, said Raoul S. Concepcion, MD, of Urology Associates in Nashville, Tennessee, and Editor-in-Chief of Urologists in Cancer Care.

These products can help urologists avoid overtreating patients, Shore said, and some, in conjunction with multiparametric MRI, can help avoid unnecessary repeat biopsies and their potential side effects, such as infection, added panelist Philippa Cheetham, MD, of Winthrop Urology and the Department of Urology at Winthrop University Hospital, in New York.

The assays will probably be used most effectively together in panels, “particularly for those people who are at high risk for prostate cancer with strong family histories,” Cheetham said.

“This whole discussion about biomarkers really comes down to this ever-evolving and growing important field of personalized medicine, precision medicine,” Concepcion said. “We have these long discussions with patients about prostate cancer, and we tell them about survival statistics, and we tell them the chances that they have nodal disease vs extracapsular disease. [But] this is all population-based data, so we’re making the assumption that, number 1, every tumor acts the same way, and number 2, everyone’s immune system acts the same way, and it’s really not that way. We know that all Gleason 3+3s, 3+4s don’t behave the same way, and it really comes down to the patient’s own individual tumor.”

Urologists are already using a number of the tests, and many more are being developed—so many that it may be difficult for

Philippa Cheetham, MD

doctors to keep track of them all.

“Many of these biomarkers are still being used in research settings,” Cheetham said, “and yet we have to be educated to counsel the patients as to whether we think this is a good idea, and understand the sensitivity and specificity of these tests.”

Weighing Active Surveillance Versus Treatment

In their discussion, the panelists focused on assays that can help urologists determine which patients with prostate cancer can safely stay on active surveillance, and which need treatment.

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