Integrating Biomarkers Into Treatment Decisions in mCRPC
July 22, 2026
Videos
PEER-TO-PEER CLINICAL CONVERSATIONS
Somatic vs. Germline Testing in Prostate Cancer: Differences and Clinical Implications
Gautam Jayram, MD
Zachary Klaassen speaks with Gautam (Tom) Jayram about the critical importance of somatic and germline testing in prostate cancer. Dr. Jayram explains that germline mutations are inherited and present in every cell, while somatic mutations are tumor-specific.
Genomic Testing and the Evolving Role of PARP Inhibitors in Prostate Cancer
Tanya Dorff, MD
Neeraj Agarwal and Tanya Dorff discuss the evolving role of genomic testing and PARP inhibitors in prostate cancer, with a focus on patient selection and treatment decision-making.
Integrating PSMA PET Imaging: From Interpretation to Systemic Therapy Selection in Castration-Resistant Prostate Cancer
A. Oliver Sartor, MD
Phillip Koo speaks with Oliver Sartor about integrating PSMA PET imaging in hormone-resistant pre-chemotherapy settings. Dr. Sartor advocates for obtaining PSMA PET scans relatively early when PSA rises after androgen deprivation therapy to identify oligometastatic disease.
The Diversity and Clinical Relevance of Germline DNA Damage Repair Gene Variants in 3005 Patients with Metastatic Prostate Cancer
Sofie Tolmeijer, PhD
Sofie Tolmeijer discusses a large cohort of 3,005 metastatic prostate cancer patients, where germline DNA damage repair variants were identified in 9%, with BRCA2, ATM and CHEK2 as the most frequent, and structural variants contributing substantially to alterations in genes like MSH2/6 and FANCA. BRCA2 carriers showed more aggressive disease features, including higher Grade Group ≥4 at diagnosis, faster progression to castration resistance, and significantly shorter median overall survival, with germline BRCA2 remaining independently associated with worse survival on multivariable analysis.
Real-World Genetic Testing Patterns in Prostate Cancer Assessed via AI: Implications for NCCN Guideline Implementation
Mitchell Singstock, MD
In a large community oncology cohort of 3 years, NCCN-indicated germline and somatic genetic testing for prostate cancer remained underutilized overall but showed significant increases over time, while testing outside NCCN guidelines rose from 4% to 18% annually. Artificial intelligence models, both rules-based and untrained general-purpose demonstrated high concordance with manual review for assigning disease stage, NCCN risk, and testing eligibility, suggesting AI could be a scalable tool to systematically identify patients who should undergo testing.
PROTRACT: A Randomized Phase II Trial Comparing ctDNA-Guided Biomarker Directed Therapy vs Patient/clinician's Choice for mCRPC Progressing After AAP
Corinne Maurice-Dror, MD
Corinee Maurice discusses the randomized phase II PROTRACT trial of 42 mCRPC patients progressing after abiraterone + prednisone, ctDNA-guided treatment selection significantly improved progression-free survival and overall survival compared with physician/patient preference, with higher PSA50 response rates.
ARPI + PARP Inhibition in mCRPC: A Statistical View Across MAGNITUDE, TALAPRO-2 and PROpel
Susan Halabi, PhD, FSCT, FASA, FASCO
Susan Halabi emphasizes that while MAGNITUDE (biomarker-selected), TALAPRO-2, and PROpel (all-comers) all show radiographic progression-free survival benefits in mCRPC with ARPI + PARP inhibitors, the magnitude of benefit is strongly driven by HRR-mutated patients—especially those with BRCA1/2 mutations—and is small, uncertain, or absent in HRR-negative patients. She cautions that subgroup hazard ratio differences without a pre-specified treatment-by-biomarker interaction test do not establish differential treatment effects, and that “all-comer” positive trials should not be interpreted as evidence that genetic testing is unnecessary.
Predictive Value of Baseline PSMA PET Imaging Biomarkers in 177Lu-DGUL Therapy: A Phase I/II trial Sub-analysis in mCRPC
Minseok Suh, MD, PhD
In a phase I/II trial of 91 mCRPC patients treated with 177Lu-DGUL (Pocuvotide Satetraxetan), 78 evaluable patients had an objective RECIST v1.1 response rate of 35.9%, PSA50 response of 66.7%, PSA80 response of 39.7%, median radiographic progression-free survival of 11.0 months, and median overall survival of 13.4 months.
