Lack of clinical use hampers potential tumour markers in PCa

There is an increasing number of publications and studies on candidate tumour markers for prostate cancer, but several obstacles prevent clinical use, according to prostate cancer specialists.

At Thematic Session 3, PCa experts discussed current work on biomarkers, while at the same time noting that practical applications are still missing. Chaired by the EAU Section for Urological Research (ESUR) Chairman Prof. Zoran Culig (AT), the session looked at the state of possible replacements for PSA-based diagnosis.

“This session is about possible new tumour markers in prostate cancer, an area in which there is an increasing number of publications and a lot of new data in the literature. However, there is a lack of clinical implementation. Studies and groups do not overlap sufficiently, so it is difficult to provide practical recommendations,” said Culig.

Culig and the Scientific Congress Office selected specialists from basic science and pathology to give state-of-the-art lectures. “The speakers will show the current status of research and hopefully provide some clear guidelines,” said Culig. The session was geared not only to academic urologists, but also practitioners.

Culig: “Our speakers will help the attendees find a way in the current literature, of which there is a lot!” Asked about the prospects for these prospective PSA-replacements, Culig speculated that more consensus conferences and standardization of procedures was required.

Gene fusions

Prof. Tapio Visakorpi (FI) lectured on gene fusions in prostate cancer, providing some careful initial conclusions based on as-yet unpublished data on 783 samples displaying TMPRSS2:ERG fusion. Visakorpi said that despite initial optimism about using these cancer-specific fusion genes as biomarkers and drug targets, most published studies now state that detection of these cells is not necessarily associated with prognosis.

“ERG fusion tumours seem to be a subclass,” Visakorpi postulated. “These fusions are rare, and they are unlikely to be useful as biomarkers alone. However, they may turn out to be useful in selecting targeted drugs if available.”

Visakorpi concluded with a timeline of different eras of medicine, with the year 2000 marking the beginning of targeted drugs, and the post 2010-era being one of personalized medicine through cyclic array sequencing and drug libraries.

Other speakers were Prof Glen Kristiansen (DE), who lectured on the role of the pathologist in clinical prognosis and Dr. Holger Sültmann (DE) who spoke on MicroRNA in PCa diagnosis who underscored the potentials and obstacles for translating miRNA markers into diagnostic applications for PCa. Abstract presentations were given by Dr. Jack Groskopf (USA) who discussed urinary PCA3 and TMPRSS2-ERG, and Dr. Monique Roobol (NL) who provided insights on studies that examine reducing unnecessary biopsies for suspicion of prostate cancer.