William K. Oh, MD, discusses how early detection with both prostate-specific antigen and magnetic resonance imaging (MRI) screening is imperative in preventing mortality in patients with high-risk prostate cancer. Precision medicine is anticipated to play a greater role in selecting treatment with novel targeted therapies.

During my time as chief medical officer at the Prostate Cancer Foundation (PCF), I began wondering why we were seeing a plateau in mortality despite all these new drugs for advanced prostate cancer. I realized that one way to prevent mortality in men with advanced prostate cancer is to identify high-risk disease early, and I believe that this is the best way to prevent lethal prostate cancer.

An example of how to achieve this is with the evidence-based screening guideline for Black men in the United States who have the highest incidence of and mortality from prostate cancer. If you do risk-adaptive screening early on, you can have an impact on overall survival. I am hopeful that this approach to screening will be adopted by the US Preventive Services Task Force (USPSTF), other screening organizations, and primary care and family medicine organizations.

Ultimately, we need to screen for high-risk disease early and steer those patients toward definitive early treatments. And screening today is more sophisticated—it is not the digital rectal exam. In fact, I think that the digital rectal exam scares away more men than it helps. Imaging-based screening tools (eg, MRI) are particularly valuable. Prostate-specific antigen is also an inexpensive—albeit imperfect—screening tool that becomes exponentially more valuable when coupled with an imaging tool such as MRI. The problem is that MRI is not cheap. However, there are types of less expensive MRIs, such as biparametric MRI (ie, no contrast).

As we continue to find new targets to treat resistant, progressive, and lethal prostate cancer, I am excited about the potential for treatments such as radioligand therapies and targeted therapies such as the AKT inhibitor capivasertib. I think that combination therapy with ADCs and bsAbs is also very promising.

Looking toward the future, I do think that we are going to see improved biomarker panels (eg, RNA and protein panels) that are going to make more targeted treatments a possibility for patients with high-risk prostate cancer. Some of the other biomarkers, such as STEAP1, TROP2, B7H3, and DLL3, show intriguing results, but it is early days. However, adding it all up, I do think that prostate cancer will be subtyped into a group of diseases for which certain drugs (eg, KLK2-targeted ADCs, prostate-specific membrane antigen–targeted bsAbs, and B7H3-targeted CAR T cells) will keep men alive longer. I think that this is a very promising area.