Prostate cancer, a multifaceted disease, frequently progresses to an advanced stage, imposing substantial therapeutic challenges. This advanced phase comprises both metastatic and locally advanced forms, demanding innovative strategies for effective management. In recent years, the discovery and application of biomarkers have emerged as a pivotal driving force in guiding treatment decisions and elevating patient outcomes. This article will delve deeper into the fundamental challenges surrounding advanced prostate cancer, the pivotal role of biomarkers in determining treatment pathways, the utility of cutting-edge imaging techniques, and the exciting prospects of biomarker-based therapies.
Q1: Hi Professor Gillessen. Our first question is, can you briefly explain what advanced prostate cancer is and how it differs from other stages of prostate cancer?
A: Yes, so hello, very nice meeting you. And so advanced prostate cancer is a quite a, let’s say, big definition.
So it includes metastatic prostate cancer, but it also includes locally advanced prostate cancer.
Q2: What are the primary challenges in treating advanced prostate cancer? How have biomarkers improved the treatment of advanced prostate cancer?
A: So when you ask this question I guess we are going more into the field of metastatic prostate cancer now because that is the field where we now using a lot of biomarkers specifically in the hormone resistance setting in the castration resistance setting.
So as we heard today also in the BT expert we had for a long time we didn’t have biomarkers in prostate cancer to make easier the treatment decision but it started with the BOP inhibitors where we found that patients with DNA repair defects specifically with BRCA mutations respond well to BOP inhibitors.
So this is now going to help us and this is for the moment we use them in the castration resistance setting in the metastatic castration resistance setting but their studies ongoing also in the hormone sensitive disease.
And then the next biomarker that we have is the PSMA. So we find PSMA positivity in PSMA PET scans and with the serognostics we can now treat these patients who are positive on the scans with a PSMA -directed radioligine therapy.
Again, this is for patients in the moment with metastatic castration resistant disease, but there is also here studies ongoing in the hormone sensitive setting.
Q3: So this is also about your research. You discussed the use of next-generation imaging for prostate cancer. How does next-generation imaging enhance the detection of biomarkers in advanced prostate cancer?
A: So the next generation imaging, we’re speaking here specifically about, as I said also before, the PSMA PET that is mostly done with gallium, sometimes with fluoride.
And that’s helping us to select the patients for the PSMA -directed therapies. Mostly for the moment it’s rehydrolygine with lutecium, but there’s also new therapies upcoming and it’s quite a nice thing I think that we now have these nice biomarker driven treatments for our patients.
So patients who don’t express the biomarkers or negative on the PSMA scans, they don’t receive treatments that have some toxicity and they cannot benefit from them.
Q4: Based on your research and the consensus from APCCC 2022, what do you see as the future of biomarker use in treating advanced prostate cancer?
A: So the future biomarkers, so there will probably be more coming. So we said already the DNA, the repair defects is one of the biomarkers we’re already using, but we will use it also in earlier lines.
And I think this is quite exciting. And then as we said, the PSMA is another one that we are using in the moment in the concentration resistant, but also here planned for early nights. And then obviously also the MSI high, that is a very small percentage, about 5% of prostate cancer patients who have that.
And as you know, this is a pan -tumor marker. So if someone is MSI high, has a good response to immune checkpoint inhibitors. So this is a new biomarker. Let’s say it’s not a new biomarker because we used it also before, but in prostate cancer it’s a quite new biomarker that in the moment again, we will use or we are using in the moment already currently for the concentration resistant setting.
But also there, it could be interesting to do trials in earlier lines.
