What are Prostate Cancer Biomarkers?
Biomarkers are measurable aspects of the body that can give information about a disease. In prostate cancer, biomarkers are genes or proteins in the cancer cells. These genes and proteins give information about how the cancer may grow. Biomarker testing is one way to help you and your doctor make treatment decisions.
Most biomarker tests are done on the small pieces of prostate tissue collected during a biopsy. Some can also be done on tissue from a prostate that has been removed during surgery.
These tests may help estimate:
- How fast-growing (aggressive) your cancer is
- How likely your cancer is to spread outside the prostate
- How likely your cancer is to come back after treatment
- If active surveillance (watching and waiting) may be an option
- If additional treatment may be helpful
A biomarker test is one tool your doctor can use. It does not replace the information from your PSA, biopsy, physical exam, imaging tests, or other standard tests. Instead, it may give extra information to help you and your doctor decide how best to manage your cancer.
Not every biomarker test is recommended for every person with prostate cancer. Your doctor can help you decide if one of these tests is right for you.
Decipher Genomic Classifier
Decipher is a genomic test that looks at the activity of certain genes in your prostate cancer tissue. It gives information about how likely your cancer is to grow fast, spread, or come back after treatment.
The test can be done on tissue from a prostate biopsy or on tissue from a prostate removed during surgery (radical prostatectomy).
For some men with Gleason 3+3 (low-risk) or Gleason 3+4 (favorable‑intermediate-risk) prostate cancer, Decipher may help you and your doctor decide between active surveillance and treatment sooner.
Decipher may also be useful after surgery. It can help estimate:
- If you may benefit from radiation therapy after surgery
- The risk that cancer may spread outside the prostate if your PSA begins to rise after surgery (biochemical recurrence)
- The risk that cancer may spread to other parts of the body in 5-10 years after surgery, especially in men whose cancer is higher-risk
The results are considered along with your other test results and clinical information when making treatment decisions.
ArteraAI Prostate Test
The ArteraAI Prostate Test uses artificial intelligence (AI) to analyze digital images of prostate biopsy tissue along with information such as your PSA level and Gleason score.
The test can give information about how your cancer is likely to grow, and if you might benefit from certain treatments.
For example, the test may help:
- Estimate your long-term risks, including if the cancer may spread or cause serious problems
- Determine if adding short-term androgen deprivation therapy (ADT) (also called hormone therapy) to radiation therapy is likely to be helpful
- Support decisions about active surveillance in some men with low-risk or favorable-intermediate-risk prostate cancer
- Estimate the risk that the cancer may spread after surgery if PSA levels start to rise, and see if adding ADT therapy to radiation may be helpful
ConfirmMDx
ConfirmMDx is used when a prostate biopsy does not find cancer, but your doctor still has concerns that cancer may be present.
The test looks for chemical “tags” around DNA. These are called epigenetic changes. These changes can suggest there may be cancer cells somewhere in the prostate, even if cancer cells were not found in the biopsy samples.
Because a biopsy samples only small areas of the prostate, it is possible for cancer to be missed. ConfirmMDx may help your doctor decide if you should have another biopsy.
Prolaris
Polaris is a genomic test that looks at genes involved in how quickly prostate cancer cells grow and divide. The test gives a Prolaris Score, which tells your doctor how fast-growing (aggressive) your cancer may be.
Prolaris can help when deciding if active surveillance is an option, or if you need treatment such as surgery or radiation.
Genomic Prostate Score (GPS)
The Genomic Prostate Score (GPS) analyzes the activity of certain genes in prostate cancer cells. The test used to be called Oncotype DX Prostate.
The test is done on prostate biopsy tissue and gives a score from 0 to 100. The score can show if your cancer may be more low- or high-risk than it appears based on the biopsy. The GPS may help when deciding between active surveillance and treatment.
ProMark
ProMark is a test for men whose biopsy shows Gleason 3+3 or 3+4 prostate cancer. The test measures certain proteins in prostate cancer cells. It gives a score between 0 and 1. This score helps estimate how aggressive the cancer is. It can help predict if more-aggressive cancer would be found in the prostate after it’s removed.
Biomarker Tests at a Glance
| Biomarker | When to Consider this Biomarker? |
|---|---|
| Decipher Genomic Classifier | For men with intermediate-risk prostate cancer see how likely their cancer is to spread, and whether it is safer to choose active surveillance or move ahead with stronger treatment. |
| ArteraAI Prostate Test | For men with intermediate-risk prostate cancer to estimate long-term outlook and whether adding hormone therapy to radiation is likely to help. |
| ConfirmMDx | For men whose first biopsy did not show cancer, but there is still concern, to help decide if another biopsy is needed. |
| Prolaris | For men with low or favorable-intermediate risk prostate cancer to understand their long-term risk and decide between monitoring and treatment. |
| Genomic Prostate Score (GPS) test | For men with low- or favorable-intermediate risk prostate cancer to predict whether more aggressive cancer might be found at surgery and to better define risk. |
| ProMark | For men with low- or favorable-intermediate risk prostate cancer to use protein markers in the tumor to help decide whether active surveillance is a good option. |
Other Types of Testing
Other biomarkers and genetic tests may be useful in certain cases.
Examples include:
- PTEN loss testing. PTEN is a gene that helps control cell growth. Loss of PTEN is linked with more aggressive prostate cancer. Testing for PTEN loss may help your doctor decide if you are a candidate for capivasertib + abiraterone acetate + ADT if you have metastatic hormone sensitive prostate cancer (mHSPC).
- Germline testing. Germline testing looks for genetic changes that you were born with and are in cells throughout your body. It is usually done with a blood or saliva sample. It can help doctors choose targeted treatments for advanced prostate cancer. Germline testing can also give information that may be important for your male family members. This is because some inherited gene changes can increase the risk of prostate cancer in a family.
- Somatic testing. Somatic testing looks for genetic changes in the cancer cells themselves. Somatic testing can help doctors choose targeted treatments, especially for men with advanced prostate cancer.
Other tests are also being studied, including tests that look at gene activity in prostate cancer cells, or look at combinations of inherited genetic changes. These tests may become useful in the future, but are not yet part of routine care.
Deciding If You Should Have a Biomarker Test
A biomarker test is most useful when the results could change what you and your doctor decide to do. Your doctor can help you decide if the information it gives is likely to be useful in your situation.
For example, a test might give information that helps you decide between active surveillance and treatment. Another test might help your doctor decide if follow-up treatment could be helpful after surgery.
Not all of these tests are available in every hospital or clinic. Insurance coverage can vary, and you may have to pay out-of-pocket costs.
Before having a biomarker test, you can ask your doctor:
- Will this test give information that you don't already have?
- Could the results change my treatment or monitoring plan?
- How reliable is the test?
- Is this test recommended for someone with my type and risk level of prostate cancer?
- Will my insurance cover the test?
- Will I have any out-of-pocket costs?
Testing is One Tool
Biomarker testing is just one part of making a prostate cancer treatment decision. Your PSA, biopsy results, cancer grade and stage, imaging results, overall health, and personal preferences are all important. Your doctor can help put all of this information together to choose the approach that is right for you.