Beyond PSMA: Preparing Your Practice for the Next Wave of Prostate Cancer Biomarkers Authors: Karim Fizazi, MD, PhD; Bertrand Tombal, MD, PhD; Alberto Briganti, MD, PhD

https://www.medscape.org/viewarticle/beyond-psma-preparing-your-practice-next-wave-prostate-2026a10006ql?page=1&sso=true&uac=148436CN&src=mkmcmr_reeng_recap_mscpedu_activity thank you for your recent participation in the activity: Beyond PSMA: Preparing Your Practice for the Next Wave of Prostate Cancer Biomarkers Below are some key learning points to help reinforce the impact of this activity. ☑ Current guidelines (EAU/NCCN) recommend early somatic testing for HRR mutations and MSI/dMMR in all metastatic patients, preferably before first-line mCRPC treatment. Testing should be performed on metastatic tissue when feasible, with primary tumor or ctDNA as alternatives when biopsy is not possible. ☑ Several biomarkers have demonstrated predictive value in clinical trials: PTEN loss predicts benefit from capivasertib + abiraterone (CAPItello-281 trial), HRR mutations (especially BRCA1/2) predict response to PARP inhibitors (AMPLITUDE trial among others), and MSI-H/dMMR status potentially requires immunotherapy treatment. ☑ Best practices include biomarker assessment with repeat PSMA PET imaging at each treatment change point and consideration of retesting with new tissue biopsy or ctDNA to capture tumor evolution. High-risk localized disease warrants early molecular characterization via IHC and NGS. ☑ Multidisciplinary approach is essential for optimal biomarker utilization, involving urologists, medical oncologists, pathologists, radiologists, genetic counselors, nurses, physiotherapists, among others to properly interpret results and implement personalized treatment strategies based on the molecular profile.