Dr Scher on the Importance of Molecular Testing in Prostate Cancer

Howard I. Scher, MD, head, Biomarker Development Program, D. Wayne Calloway Chair in Urologic Oncology, Memorial Sloan Kettering Cancer Center, discusses the evolution of molecular testing mechanisms in patients with prostate cancer and highlights the importance of making patient-centered decisions based on test results.

When oncologists test for biomarkers in patients with prostate cancer, they should understand what the presence of these biomarkers means for the patients’ prognosis and treatment options, Scher says. When the first biomarker test for prostate cancer using prostate-specific antigen (PSA) was introduced in the field, patients felt uneasy about receiving their PSA results, because these tests revealed instances of prostate cancer recurrence in some patients who had undergone surgery and were asymptomatic, Scher explains. To help patients understand the reason for their disease recurrence and guide them toward optimal treatments, oncologists need to know why patients’ PSA levels rise, Scher notes. This involved determining the rate of PSA level increases, which correlate with rapid cancer growth, according to Scher. Conversely, many patients with prostate cancer experience slow rates of PSA level increases, meaning they can live several years with their disease, Scher says.

When clinical trial investigators evaluate novel drugs, they need to ensure these agents are only tested and used in patients who need them, as cancer therapies are often associated with adverse effects that are unreasonable for patients to experience unnecessarily, Scher explains. Carefully selecting populations of patients who are eligible to receive certain therapies decreases the risk of patients experiencing therapy-related toxicities while achieving minimal clinical benefit from these treatments, Scher notes.

The treatment steps that oncologists take upon receiving biomarker test results for their patients are crucial, and these decisions should always be in the patients’ best interests, according to Scher. Now that the array of biomarker tests for patients with prostate cancer has expanded beyond PSA, oncologists should choose tests that will lead to optimal treatment options for patients, Scher concludes.

Editor's Note: Clinicians referring a patient to MSK can do so by visiting msk.org/refer, emailing referapatient@mskcc.org, or by calling 833-315-2722.