Buenos Aires, Argentina (UroToday.com) Scott Eggener, Associate Professor University of Chicago, discussed utility of biomarkers. Age adjusted mortality has decreased due to PSA screening, however, there has been over detection and over treatment of prostate cancer. Goal of biomarkers are to detect clinically significant cancer ie Gleason score 7 or higher. PHI, 4K, PCA3, select MDX are discussed. Higher PHI scores have outperformed PSA in detecting prostate cancer with inclusion at part of many current guidelines. The 4k score has important implications in detecting clinically significant cancers and outperformed the prostate cancer prevention trial and avoid up to 30% biopsies in recent studies. The 4k score has been validated in the ProTect trial with increased detection significant cancers versus PSA. PCA3 detects non-coding RNA in urine with many studies evaluating utility showing decreased use of prostate biopsy and outperformed PSA in detecting prostate cancer. MDx has high predictive value and outperformed PCPT and PCA3. TMPPRSS2:ERG and PCA3 when combined outperforms PCPT and PSA alone with avoiding biopsy by up to a third of patients. Confirm MDx is used for consideration of repeat biopsy which looks at DNA methylation in order to determine cancer on repeat biopsy with negative predictive biopsy at 90%. Costs are important to consider when evaluating biomarkers in the current healthcare climate. The aforementioned biomarkers are included in NCCN and EAU guidelines. My biggest question is given the multitude of biomarkers there is no comparative and cost effectiveness research comparing any or all of these biomarkers to determine which particular biomarker and in whom this should be performed.
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Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.