Biomarkers serve as critical navigational tools, guiding physicians on their patients’ journey through the diagnosis, treatment, and management of their specific cancer. In oncology, a biomarker may be a molecule secreted by a tumor or a specific response of the of the body to the presence of cancer. It can help in identifying early-stage cancers, forecasting how aggressive a cancer might be, or predicting how well a patient will respond to treatment. Biomarkers are also used to predict or monitor cancer recurrence.
Prostate cancer often begins its journey with the detection of prostate-specific antigen (PSA) in the blood. This biomarker, a protein produced by both normal and malignant prostate cells, can be elevated in the presence of prostate cancer. PSA testing has become a keystone in the early detection of prostate cancer, offering insight into the biological state of the prostate.
If a person has been diagnosed with cancer, biomarker testing may show whether the cancer is more likely to grow and spread, if certain cancer treatments are likely (or unlikely) to be helpful, and whether the cancer treatment is working.1
Determining treatment: Predictive biomarkers
Once prostate cancer is diagnosed, the next step involves predictive biomarkers, which help in predicting the cancer’s behavior and potential response to treatments. Genes like ER, PR, and HER2/neu, although more commonly associated with breast cancer, have parallels in prostate cancer research, where molecular markers can predict the effectiveness of therapies such as hormone treatments or chemotherapy.
One of the biggest areas of research is in immunotherapy, this is a treatment that manipulates the patient’s immune system to fight cancer with drugs or modified immune T cells. In the past several years, immunotherapy has had great success in some patients with certain types of cancer, but not all patients respond to this type of treatment. I have written about this in previous articles I have done on cancer and treatments — I believe this type of treatment has great potential with further development.2
There is a significant amount of research focused on discovering biomarkers that could identify which patients are likely to respond to immunotherapy. In some types of cancer, the presence or absence of immune molecules in cancer cells has been associated with determining whether a patient will have a better or worse response to immunotherapy.
Biomarkers can also be used to help physicians determine if there are clinical trials available for their patients. Some trials, called basket studies, are based on the biomarkers in tumors and/or cells instead of the primary body site of the cancer. There are other trials that are using biomarkers to match treatments based on the gene characteristics or genetic changes in the patient’s cancer.
Monitoring treatment: Prognostic biomarkers
As treatment begins, prognostic biomarkers are an effective way of determining the efficacy of the chosen treatment. There are specific assays that can examine a panel of genes within the tumor biopsy to provide a recurrence risk score, thus offering a prognostic outlook on the likelihood of cancer returning.
Biomarkers have also shown benefits in monitoring how well a treatment is working over time. There is the potential that these biomarkers can be used as alternatives to the more common method of monitoring, that is, image-based tests, such as CT scans and MRIs. Such biomarkers are invaluable in tailoring patient-specific follow-up care and determining the frequency and type of follow up and continued care strategies.
Impact of biomarkers: Prostate cancer and precision medicine
The journey of a biomarker in prostate cancer is progressive. From the initial diagnosis through PSA levels to the nuanced understanding of the disease’s molecular landscape, biomarkers shape the course of treatment. They offer a personalized approach, ensuring that each patient receives care tailored to the unique characteristics of their cancer.
As research continues to evolve, biomarkers stand at the forefront of precision oncology, offering a ray of hope for patients who are receiving a devastating diagnosis. Their physicians are able to provide them with more information, access to more options and a personalized approach to have better outcomes for their cancer journey.
How can patients advocate for biomarker testing?
Patients can advocate for biomarker testing by taking several proactive steps to ensure they receive the most personalized care possible. Here are some suggestions:
- Educate yourself: Learn about the types of biomarker tests available and how they can influence treatment decisions. Understanding the potential benefits can help you make informed requests for testing.
- Discussion with healthcare provider: Bring up the topic of biomarker testing with your doctor. Ask about the tests that are relevant to your condition and how they might impact your treatment plan. Ask if you can speak with your pathologist. The pathologist who diagnosed you is the first line of care in your journey. If they use digital pathology, you may even be able to see images of your specific cancer tumor or cells as well as get a description and insights from the pathologist that are specific to your disease. This can be empowering for some patients.
- Insurance coverage: Check with your insurance provider to see if biomarker testing is covered under your plan. If not, discuss with your healthcare provider about the necessity of the test, which might help in getting the coverage.
- Seek support: Contact patient advocacy groups or organizations that specialize in your condition. They can provide resources and guidance on accessing biomarker testing.
- Legislative action: Support efforts to expand insurance coverage of comprehensive biomarker testing. Some states have enacted legislation to improve access to these tests.3
- Financial assistance programs: Explore financial aid options through foundations and pharmaceutical programs that may cover the cost of biomarker testing.4
Any and all of the above actions can enable a patient to be an active participant in their care plan and to help them fight for the treatment and coverage that they and their physicians determine is best for them.
In summary, this article was meant to provide a view of the critical role biomarkers play in the journey of prostate cancer, from diagnosis to treatment and beyond. It highlights the transformative impact these biological indicators have on patient care, emphasizing the shift towards personalized medicine in oncology.
References
1. Biomarker tests and cancer treatment. Cancer.org. Accessed May 29, 2024. https://www.cancer.org/cancer/diagnosis-staging/tests/biomarker-tests.html.
2. Clifford LJ. Key points of intersection in diagnosis and treatment of cancer. Medical Laboratory Observer. Published October 18, 2023. Accessed May 29, 2024. https://www.mlo-online.com/disease/cancer/article/53073961/key-points-of-intersection-in-diagnosis-and-treatment-of-cancer.
3. National. American Cancer Society Cancer Action Network. Accessed May 29, 2024. https://www.fightcancer.org/states/national/actions.
4. Financial advocacy. Accessed May 29, 2024. https://www.accc-cancer.org/home/learn/financial-advocacy?.
