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Phenotypes may provide a novel approach for precision medicine

How Can Phenotypic Biomarkers Increase the Use of Precision Medicine in Advanced Prostate Cancer?

A. Oliver Sartor, MD

Dr. Sartor explores how phenotypic biomarkers, which can be detected through noninvasive diagnostics such as prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging, are emerging as a novel approach to facilitate decision making in advanced prostate cancer.

Phenotypic precision medicine may facilitate decision making based on observable characteristics that are produced through the interaction of a genotype and environment.1-8 Phenotypes can be assessed through noninvasive diagnostics, such as PSMA PET/computed tomography (CT) imaging.4,9 

In contrast, the analysis of genotypes requires the collection of biologic samples, which can be complicated to do in advanced prostate cancer.10

Limitations of prostate cancer biopsies include…


Limitations of prostate cancer biopsies



To overcome these challenges in prostate cancer, phenotypic biomarkers can be characterized through noninvasive diagnostics such as PET imaging.9,14,15

PET imaging leverages radiotracers to visualize cancer tissue at a high sensitivity and specificity.16


Commonly used radiotracers include…


Commonly used radiotracers in prostate cancer

CT, computed tomography; FDA, US Food and Drug Administration; 18F-FDG, 18fluorodeoxyglucose; NCCN, National Comprehensive Cancer Network; PET, positron emission tomography; PSA, prostate-specific antigen; PSMA, prostate-specific membrane antigen.

aIn a meta-analysis of the diagnostic performance of 11C-choline carried out on 8 selected studies including 276 patients.22
bIn a head-to-head comparison performed in 50 patients radically treated for prostate cancer and presenting with rising PSA levels.25
cIn a prospective, single-center, open-label comparative study, 50 adults with biochemical recurrence after radical prostatectomy and PSA levels <2 ng/mL.27

PSMA PET/CT imaging is a noninvasive diagnostic that can detect phenotypic biomarkers, such as PSMA, that may simplify your approach to precision medicine.1-3,5-7,14,15


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NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.


1. ​Sant GR et al. NPJ Precis Oncol. 2017;1(1):21. 2. Seyhan AA, Carini C. J Transl Med. 2019;17:114. 3. Aronson SJ, Rehm HL. Nature. 2015;526(7573):336-342. 4. Rowe SP et al. Prostate Cancer Prostatic Dis. 2016;19(3):223-230. 5. Hofman MS et al. Lancet. 2020;395(10231):1208-1216. 6. Müller J et al. Eur J Nucl Med Mol Imaging. 2019;46(4):889-900. 7. Calais J et al. J Nucl Med. 2018;59(3):434-441. 8. Phenotype. Merriam-Webster. Accessed July 10, 2020. 9. Kratochwil C et al. J Nucl Med. 2016;57:1170-1176. 10. Friedlander TW et al. Am Soc Clin Oncol Educ Book. 2017;37:358-369. 11. Łukaszewski B et al. Contemp Oncol (Pozn). 2017;21(2):98-103. 12. Ross RW et al. Clin Cancer Res. 2005;11(22):8109-8113. 13. Ku SY et al. Nat Rev Urol. 2019;16(11):645-654. 14. Rowe SP et al. J Nucl Med. 2015;56(7):1003-1010. 15. Osborne JR et al. J Urol. 2014;191(5):1439-1445. 16. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prostate Cancer V.1.2021. © National Comprehensive Cancer Network, Inc. 2021. All rights reserved. Accessed February 17, 2021. To view the most recent and complete version of the guideline, go online to 17. Fludeoxyglucose F18 injection [prescribing information]. Manhasset, NY: The Feinstein Institute for Medical Research; 2010. 18. Wallitt KL et al. Radiographics. 2017;37(5):1512-1536. 19. Jadvar H. Semin Nucl Med. 2016;46(6):502-506. 20. Choline C11 injection [prescribing information]. Rochester, MN: Mayo Clinic; 2012. 21. Walker SM et al. Abdom Radiol (NY). 2020;45(7):2165-2175. 22. Evangelista L et al. Clin Transl Imaging. 2013;1:99-109. 23. Nanni C et al. Eur J Nucl Med Mol Imaging. 2016;43(9):1601-1610. 24. Axumin [prescribing information]. Oxford, UK: Blue Earth Diagnostics; 2016. 25. Nanni C et al. Clin Nucl Med. 2015;40(8):e386-e391. 26. Schuster DM et al. J Urol. 2014;191(5):1446-1453. 27. Calais J et al. Lancet Oncol. 2019;20(9):1286-1294.

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