medwireNews: ASCO have published two sets of prostate cancer guidelines advising on optimal imaging strategies for advanced prostate cancer care and the use of tissue-based molecular biomarker panels in men with localized disease.
Both sets of guidelines are available in the Journal of Clinical Oncology.
After reviewing data from 17 systematic reviews and 18 primary research studies, the expert panel recommends conventional screening (CT, prostate MRI, and bone scans) or next-generation imaging (PET, PET–CT, PET–MRI, and whole-body MRI) be used for all men with a new diagnosis of high-risk cancer; a confirmed or suspected diagnosis of metastatic disease; recurrent prostate cancer; or progressive disease on treatment.
Specific recommendations are given for different clinical scenarios, such as the strong recommendation to use next-generation imaging to assess men considering salvage radiotherapy due to a rising prostate-specific antigen level, and the moderate recommendation to use next-generation imaging to clarify treatment options for men with metastatic hormone-sensitive disease.
A second multidisciplinary expert panel has published guidelines on the use of tissue-based prostate cancer biomarkers in patients with localized prostate cancer, based on data from 108 reports.
The team recommends that commercially available molecular biomarker assays may be used to help identify patients who may benefit from active surveillance but that routine ordering of such tests is not recommended.
In particular, five commercially available tests were identified that are able to assist with initial risk stratification – Oncotype Dx Prostate, Prolaris, Decipher, Decipher PORTOS, and ProMark.
Similarly, commercial assays may be considered alongside routine clinical factors for the diagnosis of clinically significant disease or guiding the choice of adjuvant versus salvage radiotherapy where the result may affect management, but again, such assays should not be routinely used.
Moreover, the expert panel emphasizes that molecular biomarkers outside of the commercial assays “do not have sufficient data to be clinically actionable” and therefore should not be offered to patients.
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