PCa17: What to expect in future prostate cancer management

The number of promising biomarkers at different molecular levels are increasing, accompanied by numerous testing in the market, but cancer experts say independent and prospective validation is crucial to help the medical community eventually provide optimal care to cancer patients.

“We can expect several developments in the field of biomarkers and there are promising biomarkers for PCa at all molecular levels such as in proteomics, transcriptomics and genomics,” said Prof. M. Wirth (DE) in an update lecture at the final plenary session of the EAU Update on Prostate Cancer (PCa17) in Vienna.

Wirth noted the increasing number of research studies on diagnostic PCa markers and higher number of tests in the market. He described the ideal biomarkers as non-invasive/minimally invasive, with high accuracy and performance, and accessible at low costs. He gave an overview on prognostic protein markers, microRNAs and IncRNAs as potential biomarkers. He also underlined that DNA sequencing as the most crucial element and described it as an “engine of genome research.”

“The future of medicine lies in comprehensive approaches for marker selection and evaluation such as artificial intelligence, neuronal networks, and machine learning,” said Wirth as he reiterated that validation is necessary.

“There are numerous promising biomarkers but independent, prospective validation is needed,” he said whilst noting that the future of PCa biomarkers hinges on single-cell analysis, liquid biopsies, and “omics” which at several levels are made feasible due to cost reduction for high-throughput analysis and new analytical approaches.

In the same session Mark Emberton (GB) discussed the future of focal therapy, Maurizio Brausi (IT) tackled the treatment of oligometastatic disease, Louis Denis (BE) provided an insightful overview of a holistic, patient-centred care, and Jochen Walz (FR) gave a comprehensive view of the future of molecular and functional imaging.

A selection of their key messages are:

• “Our therapies should be complementary not mutually exclusive. Depending on disease severity, the range extends from Active Surveillance, focal therapy to whole gland treatment.” (Emberton)
• “One challenge to holistic care is the lack of integration in treatment and care and organized patient support groups. What we need are correct costs/efficacy and to deal with complementary, integrative medicine.” (Denis)
• “Current PET tracers are an improvement and there clearly remains a need for more sensitive and specific tracers.” (Walz)
• “Some oligo-metastatic cancers progress slowly and can be a separate entity. Local therapy (RP and RT) seem safe and reduce the need of palliative treatment. (Brausi)