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Cell-free DNA in prostate cancer and treatment selection
Kate McKendry1, Corinne Maurice-Dror1,2, Kim N Chi1,2
1Department of Medical Oncology, BC Cancer - Vancouver, Vancouver, Canada.
Introduction:
Metastatic prostate cancer is a leading cause of global cancer-related mortality. Contemporary treatment strategies are increasingly guided by genomic analyses, which are typically performed on archival or newly obtained biopsies. Nevertheless, tissue biopsies in this context face significant technical and clinical challenges. Circulating tumor DNA (ctDNA) testing from peripheral blood is a promising approach that addresses many of these limitations and enables sequential testing.
Areas Covered:
This review examines the evidence for ctDNA in prostate cancer management and considers where it may be most effectively integrated into clinical practice. We discuss the strengths and limitations of ctDNA-based diagnostics, the key principles guiding clinical interpretation, and future directions, including novel applications under development in clinical trials.
Expert Opinion:
In the metastatic castration-resistant prostate cancer (mCRPC) setting, ctDNA genomic profiling is an established method to identify patients eligible for PARP inhibitor therapy, and an emerging biomarker for prognostication, treatment selection, and response assessment. The results of ongoing clinical trials will inform on the future role of ctDNA for prostate cancer.
Insights
Circulating tumor DNA (ctDNA) testing offers a less invasive alternative to tissue biopsies for metastatic prostate cancer management. This blood test aids in treatment selection, response assessment, and prognostication, especially in castration-resistant cases.
Area of Science:
- Oncology
- Genomics
- Molecular Diagnostics
Background:
- Metastatic prostate cancer is a major global health concern, with treatment decisions often relying on genomic analysis.
- Traditional tissue biopsies present significant clinical and technical challenges for patients.
- Circulating tumor DNA (ctDNA) testing from blood emerges as a viable alternative, enabling sequential monitoring.
Purpose of the Study:
- To review the evidence supporting ctDNA in prostate cancer management.
- To identify optimal integration points for ctDNA diagnostics in clinical practice.
- To discuss the strengths, limitations, and future applications of ctDNA testing.
Main Methods:
- Review of existing literature and clinical trial data on ctDNA in prostate cancer.
- Analysis of ctDNA's role in identifying eligible patients for specific therapies (e.g., PARP inhibitors).
- Evaluation of ctDNA as a biomarker for prognostication and treatment response.
Main Results:
- ctDNA profiling is established for identifying patients eligible for PARP inhibitor therapy in metastatic castration-resistant prostate cancer (mCRPC).
- ctDNA serves as an emerging biomarker for prognostication, treatment selection, and monitoring treatment response.
- Ongoing clinical trials are crucial for defining the future clinical utility of ctDNA in prostate cancer.
Conclusions:
- ctDNA testing provides a valuable, less invasive tool for managing metastatic prostate cancer.
- Genomic profiling via ctDNA is key for personalized treatment strategies in mCRPC.
- Further research and clinical trials will solidify the role of ctDNA in advancing prostate cancer care.
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