Risk Management & Treatment

Biomarkers, targeted and immunotherapies for prostate cancer

This section covers the following topics:

Genetic tests for inherited mutations for treatment selection

Any person diagnosed with mCRPC meets national guidelines for genetic testing for an inherited mutation. Genetic testing may be used to guide treatment selection.  

  • Men with mCRPC who test positive for an inherited mutation in BRCA1, BRCA2, ATM, CHEK2, PALB2 or other gene linked to a certain type of DNA damage repair may benefit from a type of targeted therapy known as a PARP inhibitor
  • Men who test positive for an inherited mutation linked to Lynch syndrome, may benefit from the immunotherapy pembrolizumab (Keytruda). 

Biomarker tests

Biomarker tests look at samples of blood, tumor or other tissue for changes or abnormalities caused by cancer. These tests can give doctors clues about the cancer, including:

  • how fast the cancer is growing
  • which treatments are most likely to work
  • whether or not the cancer is responding to treatment or growing
  • whether or not the cancer has come back after remission

Biomarkers for treatment selection

Biomarker tests may be used to select treatments, and help patients avoid side effects from treatments that will not work for them. Biomarker tests used to select a specific treatment are sometimes called "companion diagnostic tests." These tests may be done on tumor tissue or (in many cases) on blood. See our Biomarker Testing section for more information. 

Experts recommend biomarker testing for prostate cancer based on risk groups.

  • Men with low and favorable-intermediate-risk prostate cancer and a life expectancy of > 10 years should consider multi-gene tumor testing. Multi-gene tumor testing can help predict how aggressive the prostate cancer is and guide treatment.
    • Prostate multi-gene tumor tests include Decipher, Oncotype DX Prostate, Prolaris and ProMark.
  • Men with regional or metastic prostate cancer should consider tumor testing for:
    • An abnormality known as homologous recombination deficiency (HRD).
      • If tumor mutations in BRCA1, BRCA2, PALB2, ATM or CHEK2 are found, patients should be considered for referral for genetic counseling and testing for an inherited mutation. 
    • An abnormality known as microsatellite instability" (MSI-H or MSI-high) also known as "mismatch repair deficiency" (dMMR or MMR-D).
      • MSI-high cancers are common in people with a Lynch syndrome gene mutations. People with advanced/metastatic MSI-high prostate cancer may respond well to an immunotherapy agent. 
  • Additional biomarker tests that may be used for metastic castration-resistant prostate cancer (mCRPC) include AR-V7 testing. AR-V7 stands for Androgen Receptor Variant 7.  AR-V7 is a blood test that looks for a form of the androgen receptor that makes androgen therapy less effective. AR-V7 testing can help identify patients who would not benefit from androgen receptor therapies.

Immunotherapies 

Immunotherapies are cancer treatments that help the body’s immune system detect and attack cancer cells. 

  • Immune checkpoint inhibitors are a type of immunotherapy most often used to treat advanced/metastatic prostate cancer that have MSI-H or dMMR; usually after other treatments have been tried.
    • Keytruda (pembrolizumab) may be used to treat patients with castration resistant prostate cancer that is MSI-H or dMMR and have had one line of therapy affecting the whole body.
  • Cancer treatment vaccines are a type of immunotherapy that uses a patient’s own cancer cells to boost their immune system.
    • Provenge (sipuleucel-T) may be used to treat patients with metastatic prostate cancer whose disease has progressed aftger hormonal treatment who have either no or very minimal symptoms related to the prostate cancer.

Targeted therapies

The PARP inhibitor, Lynparza (olaparib) has received FDA-approval to treat men with metastatic, castration-resistent prostate cancer, who have a mutation in BRCA1, BRCA2, ATM or other gene linked to a certain type of DNA damage repair. Lynparza may be used to treat men whose prostate cancer has progressed on enzalutamide (Xtandi) or abiraterone (Zytiga).

The PARP inhibitor, Lynparza (olaparib) has received FDA-approval to treat men with metastatic, castration-resistent prostate cancer, who have a mutation in BRCA1, BRCA2, ATM or other gene linked to a certain type of DNA damage repair. Lynparza may be used to treat men whose prostate cancer has progressed on enzalutamide (Xtandi) or abiraterone (Zytiga).

Table of targeted and immunotherapies for prostate cancer

Name of drug Cancer stage Indication Biomarker Type of agent
Lynparza
(olaparib)
Metastatic castration-resistant prostate cancer (mCRPC) Men with mCRPC whose cancer has progressed following treatment with Xtandi (enzalutamide) or  Zytiga (abiraterone) Inherited mutation in BRCA1 or BRCA2 or tumor mutation one of
the following genes: ATM, BRCA1, BRCA2, BARD1, BRIP1, CDK12, CHEK2, FANCL, PALB2, RAD51B, RAD51CRAD51D ,  RAD54
PARP inhibitor
Rubraca
(rucaparib)
Metastatic castration-resistant prostate cancer (mCRPC) Men with mCRPC who have been treated with androgen receptor-directed therapy and a taxane-based chemotherapy Inherited or acquired (tumor) mutation in BRCA1 or BRCA2 PARP inhibitor
Provenge (sipuleucel-T) Metastatic castration resistant prostate cancer (mCRPC) For the treatment of asymptomatic or minimally symptomatic metastatic castrate resistant prostate cancer No biomarker needed Cancer vaccine
Keytruda (pembrolizumab) Metastatic or unresectable solid tumors For treatment of solid tumors that have progressed after treatment and for which there are no other treatment options MSI-H (Microsatellite Instability High) or MMR-D (Mismatch Repair Deficiency Immune checkpoint inhibitor
Keytruda (pembrolizumab) Metastatic or unresectable solid tumors

For the treatment of solid tumors that have progressed following prior treatment and for which there are no satisfactory alternative treatment options

Tumor Mutational Burden High (TMB-H) Immune checkpoint inhibitor
Vitrakvi (larotrectinib) Metastatic solid tumors For treatment in metastatic solid tumors where surgical resection is likely to result in severe morbidity, and  for which there are no satisfactory alternative treatments or the cancer progressed following treatment NTRK fusion Kinase inhibitor

 

find-support

If you have prostate cancer, you can find peer support through the following resources:

  • FORCE support:
  • Other organizations that offer support:
    • Us Too is an international nonprofit organization for men with prostate cancer and their loved ones. 
    • ZERO - The End to Prostate Cancer is a nonprofit organization that provides information and support resources for men with prostate cancer. 
paying-for-service

The majority of public and private health insurance plans are required to cover cancer diagnosis and treatment; copays, coinsurance and deductibles often apply. Patient costs and coverage for specific doctors, facilities or treatments may vary based on your health plan. Visit our section on Insurance and Paying for Care: Treatment  for more information, links to sample appeal letters and other resources. 

Some pharmaceutical companies and laboratories have assistance programs that help cover the cost for their medications, tumor testing or genetic testing for an inherited mutation: 

Organizations that offer co-pay assistance:

Other resources:

  • The American Cancer Society provides information and resources on covering the cost of cancer care. Public assistance, such as Medicaid may be available if you are ineligible for other programs. 
  • Needy Meds: Assistance programs to help patients with cost of medications and other healthcare.
  • Triage Cancer offers tools and resources to help individuals cope with the financial aspects of a cancer diagnosis.
clinical-trials

The following cancer treatment studies are open to people diagnosed with prostate cancer. 

Advanced solid tumors (including breast, ovarian, pancreatic, prostate or others) 

Prostate cancer 

Visit our Research Search and Enroll Tool to find additional cancer treatment studies.