Liquid Biopsies in Prostate Cancer


Accessing the Latest Developments in Liquid Biopsies, with Lauren Leiman and Jenn Dickey - YouTube

Liquid Biopsies in Prostate Cancer: Progress, Promise, and Patient Advocacy

A comprehensive look at the latest developments in blood-based cancer detection and monitoring

The Promise of a Simple Blood Test

What if detecting prostate cancer recurrence or monitoring treatment response could be as simple as a routine blood draw? This vision is becoming reality through liquid biopsies—blood tests that can detect circulating tumor DNA (ctDNA) and other cancer-related biomarkers without the need for invasive tissue biopsies.

In a recent discussion hosted by the Cancer Patient Lab, experts from the Blood Profiling Atlas in Cancer (BloodPAC) and industry leaders outlined both the remarkable progress and ongoing challenges in bringing liquid biopsy technology to prostate cancer patients.

What Are Liquid Biopsies?

As Jennifer Dicki, head of regulatory affairs at LabCorp Oncology, explained during the discussion, liquid biopsies work by detecting tumor cells and tumor DNA that float in circulation when cancer is present. "A liquid biopsy is basically using biofluids, generally blood, but taking that circulating tumor DNA or cells out of the body and doing clinical examinations on that tumor DNA that's available in your blood," she said.

This technology offers several advantages over traditional tissue biopsies:

  • Less invasive: Only requires a blood draw
  • Faster results: Can provide information more quickly than surgical biopsies
  • Real-time monitoring: Allows for ongoing assessment of treatment response
  • Broader tumor sampling: Captures genetic information from multiple metastatic sites

Current Applications in Prostate Cancer

Liquid biopsies are already being used in prostate cancer care in several ways:

1. Treatment Selection

FDA-approved tests like FoundationOne Liquid CDx can identify patients with metastatic castration-resistant prostate cancer (mCRPC) who have BRCA1, BRCA2, or ATM gene mutations and may benefit from PARP inhibitor treatments like olaparib (Lynparza).

2. Monitoring Treatment Response

Blood tests can detect the development of resistance mutations, helping doctors know when it's time to change treatments. This is particularly valuable for patients on androgen receptor-targeted therapies.

3. Prognostic Assessment

Recent research shows that the percentage of circulating tumor DNA in blood samples strongly predicts overall survival and treatment response in advanced prostate cancer patients, outperforming traditional clinical factors.

The Reality Check: Challenges Remain

While the science is promising, experts emphasize that significant challenges remain before liquid biopsies become standard care:

Sensitivity Issues: Not all prostate cancers shed detectable amounts of DNA into the bloodstream, particularly early-stage cancers. Research indicates that patients with less than 2% circulating tumor DNA may not have sufficient material for reliable testing.

Cost and Accessibility: Current tests are expensive and may not be covered by all insurance plans. The technology requires specialized equipment and trained personnel, making it less accessible to smaller medical centers.

Clinical Validation: While tests can detect cancer-related changes, more research is needed to prove that acting on these results improves patient outcomes and survival.

The Patient Advocacy Perspective

The discussion revealed an important tension between scientific advancement and patient needs. Rick Davis from the Anand organization (a patient advocacy group) emphasized the critical importance of including patient voices in developing these technologies.

"The patient voice has to be loud," Davis stressed. "There has to be somebody saying, 'This is how this type of test affects me and why I need it.'" He pointed to the real-world example of Roger, a meeting participant whose early pancreatic cancer was detected through a liquid biopsy performed against his physician's advice—potentially saving his life.

Paul, another participant with prostate cancer, described how he actively researched liquid biopsy options and requested ctDNA testing from his oncologist to monitor for minimal residual disease that might not be detected by standard PSA tests.

The Take-Up Problem

A concerning reality highlighted during the discussion is the low adoption rate of genomic testing among community oncologists. Research shows that testing rates for actionable mutations in prostate cancer remain "atrocious," with many patients not receiving potentially life-saving genetic profiling.

This underscores the need for better education—not just for patients, but for healthcare providers who may not be familiar with these rapidly evolving technologies.

What's on the Horizon

Several exciting developments are in the pipeline:

Minimal Residual Disease (MRD) Detection: Tests that can detect microscopic amounts of cancer remaining after treatment, potentially allowing for earlier intervention before cancer becomes visible on scans.

Multi-Cancer Early Detection: Blood tests that could screen for multiple cancer types simultaneously, though these are not yet FDA-approved and face challenges with false positives and clinical utility.

Improved Sensitivity: Next-generation assays using methylation patterns and other biomarkers may be able to detect cancer signals that current DNA-based tests miss.

What This Means for Patients

For prostate cancer patients and their families, liquid biopsies represent both opportunity and complexity:

Immediate Benefits:

  • FDA-approved tests are available now for specific situations, particularly in advanced prostate cancer
  • These tests can help guide treatment decisions and avoid unnecessary procedures
  • Blood-based monitoring may provide earlier detection of treatment resistance

Important Considerations:

  • Not all liquid biopsies are FDA-approved or covered by insurance
  • Results should always be interpreted in consultation with an oncologist familiar with these technologies
  • False positives and negatives remain possible

Patient Advocacy Role:

  • Educated patients can drive adoption by requesting these tests from their doctors
  • Patient advocacy groups play a crucial role in ensuring tests are developed with real-world needs in mind
  • Sharing experiences (both positive and negative) helps improve the technology

Moving Forward: The Need for Balance

The BloodPAC consortium represents an important model for advancing liquid biopsy technology through collaboration between industry, academia, and government agencies. However, the discussion highlighted the ongoing need to bridge the gap between scientific innovation and patient care.

As Lauren Lyman, BloodPAC's executive director, noted, the organization's focus remains on creating standards and frameworks that will ultimately benefit patients. But as patient advocates emphasized, this work must include—not just consider—the patient perspective from the beginning.

Practical Steps for Patients

If you're interested in liquid biopsy testing:

  1. Discuss with your oncologist: Ask about FDA-approved liquid biopsy tests that might be relevant to your specific situation
  2. Understand insurance coverage: Check whether your insurance covers specific tests before proceeding
  3. Consider clinical trials: Many trials are investigating liquid biopsy-guided treatment approaches
  4. Stay informed: Follow reputable sources for updates on FDA approvals and clinical guidelines
  5. Connect with advocacy groups: Organizations like IPCSG can provide peer support and up-to-date information

Questions to ask your doctor:

  • Would a liquid biopsy test provide useful information for my specific situation?
  • What are the potential benefits and limitations?
  • How would the results change my treatment plan?
  • Is this test FDA-approved for my condition?
  • Will my insurance cover the cost?

The Bottom Line

Liquid biopsies represent a significant advancement in cancer care, offering the promise of personalized, precision treatment based on the unique genetic profile of each patient's cancer. For prostate cancer patients, these tests are already providing valuable information for treatment selection and monitoring.

However, realizing the full potential of this technology will require continued collaboration between researchers, clinicians, industry, and—critically—patients themselves. As the discussion made clear, patient advocacy and education remain essential drivers of progress.

The future of prostate cancer care is increasingly personalized, less invasive, and more responsive to the individual needs of each patient. Liquid biopsies are an important part of that future—one that's arriving now for many patients and holds even greater promise for tomorrow.

This article is based on a recent Cancer Patient Lab meeting featuring experts from BloodPAC and LabCorp Oncology, supplemented with current research findings. For personalized medical advice, always consult with your healthcare team.

Sources and Citations

  1. Dicki, J., et al. Blood Profiling Atlas in Cancer (BloodPAC) presentation. Cancer Patient Lab Meeting, 2025.
  2. Lyman, L. BloodPAC Executive Director presentation. Cancer Patient Lab Meeting, 2025.
  3. Wyatt, A.W., et al. "Prediction of plasma ctDNA fraction and prognostic implications of liquid biopsy in advanced prostate cancer." Nature Communications, vol. 15, 2024, article 1450. https://www.nature.com/articles/s41467-024-45475-w
  4. U.S. Food and Drug Administration. "FDA approves liquid biopsy NGS companion diagnostic test for multiple cancers and biomarkers." FDA News Release, November 6, 2020. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-liquid-biopsy-ngs-companion-diagnostic-test-multiple-cancers-and-biomarkers
  5. National Cancer Institute. "FDA Approves Blood Tests That Can Help Guide Cancer Treatment." Cancer Currents Blog, 2020. https://www.cancer.gov/news-events/cancer-currents-blog/2020/fda-guardant-360-foundation-one-cancer-liquid-biopsy
  6. Boerrigter, E., et al. "Blood-based liquid biopsies for prostate cancer: clinical opportunities and challenges." British Journal of Cancer, vol. 127, 2022, pp. 1394-1406. https://www.nature.com/articles/s41416-022-01881-9
  7. American Society of Clinical Oncology. "Liquid Biopsy Approaches for Cancer Characterization, Residual Disease Detection, and Therapy Monitoring." ASCO Educational Book, 2025. https://ascopubs.org/doi/10.1200/EDBK-25-481114
  8. Francesca, F., et al. "Liquid Biopsy in Prostate Cancer Management—Current Challenges and Future Perspectives." PMC, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9265840/
  9. Johns Hopkins Medicine. "Prostate Cancer: Advancements in Screenings." November 11, 2021. https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostate-cancer-advancements-in-screenings
  10. American Urological Association. "Early Detection of Prostate Cancer: AUA/SUO Guideline (2023)." https://www.auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guidelines
  11. "Liquid Biomarkers in Prostate Cancer Diagnosis: Current Status and Emerging Prospects." World Journal of Men's Health, 2024. https://wjmh.org/DOIx.php?id=10.5534/wjmh.230386
  12. "Research progress of CTC, ctDNA, and EVs in cancer liquid biopsy." PMC, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10850354/

Note: All URLs have been verified as of publication date. For the most current information, readers should consult the latest medical literature and speak with their healthcare providers.

 

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