Biomarkers For Localized Prostate Cancer: Are Molecular Predictive Markers Ready For Prime-Time?

Tyler F. Stewart, MD, Associate Clinical Professor of Medicine, University of California, San Diego, San Diego, California, examines whether molecular predictive biomarkers are ready to guide therapy decisions in localized bladder cancer. Dr. Stewart reviews the current biomarker landscape, with emphasis on circulating tumor DNA as the most clinically mature tool in this space. He outlines multiple biomarker platforms under investigation, including blood-based, urine-based, genomic, transcriptomic, and digital pathology approaches. ctDNA is explored in depth, including assay methodologies and its strong prognostic value across the perioperative disease course. Key data from adjuvant immunotherapy trials are reviewed. While IMvigor010 failed to show benefit in unselected patients, ctDNA-positive subgroups experienced significant improvements with adjuvant atezolizumab. IMvigor011 further validates ctDNA-guided therapy, demonstrating survival benefit in ctDNA-positive patients and highlighting the importance of serial monitoring, as many patients convert from negative to positive over time. Dr. Stewart also discusses the MODERN trial, which is evaluating escalation and de-escalation strategies based on ctDNA status, and contrasts these findings with perioperative data from the NIAGARA trial, where ctDNA was prognostic but not predictive of immunotherapy benefit. He concludes that ctDNA is ready for use in the adjuvant setting but should not yet be used to omit perioperative therapy or discontinue treatment. Dr. Stewart highlights the future promise for urinary biomarkers in bladder cancer management. Don't forget to join the GRU Community: https://grandroundsinurology.com/regi... Follow us on Twitter/X: https://x.com/GRUrology And like and subscribe to us here on YouTube!