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Going beyond: Pushing the boundaries of prostate cancer diagnostics
Use serum Chromogranin A (CgA) on Thermo Scientific B·R·A·H·M·S KRYPTOR instruments as an aid in early identification of neuroendocrine differentiation of prostate cancer during monitoring of all your patients under hormonal therapy.
Guidance beyond
Prostate cancer is the most prevalent (by quite a margin) cancers in men worldwide.¹
Early detection and regular monitoring of prostate cancer are crucial for effective treatment. While prostate specific antigen (PSA) is gold standard in prostate cancer detection and monitoring. CgA adds valuable insights to detect treatment emergent neuroendocrine prostate cancer (NEPC).
B·R·A·H·M·S CgA KRYPTOR:
Complementary detection tool in prostate cancer
The Thermo Scientific B·R·A·H·M·S CgA II KRYPTOR automated assay is useful throughout your patient's prostate cancer journey, with a focus on follow-up patients under hormonal therapy, including Abiraterone.2,3 Standard therapeutic approaches for the treatment of prostate cancer depend on the disease progression and can include:
- Watchful waiting
- chemotherapy/readiotherapy/surgery
- Hormonal therapy/androgen deprivation therapy (ADT)
*up to 62% of patients with non-metastatic prostate cancer receiving ADT (depending on region)4
Expanding prostate cancer diagnostics and care
Incorporating CgA allows healthcare professionals to achieve greater diagnostic insights and facilitates more advanced patient care.
- Neuroendocrine prostate cancer is an aggressive subtype of prostate cancer characterized by neuroendocrine differentiated cells
- When progressing, up to 40% of prostate cancers develop neuroendocrine differentiation (NED)7
- ADT promotes development of NEPC by neurodendocrine differentiation
- NEPC can proliferate independently from androgen receptor signaling and is ususally resistant to ADT: castration-resistant prostate cancer (CRPC). For CRPC, a change of therapy is necessary
- Monitoring is critical to detect:
- Neuroendocrine differentiation
- Treatment-emergent resistance to androgen deprivation therapy
- Risk of progression
- PSA is often low in NEPC patients and provides limited clinical benefit in this indication
Documented utility of circulating CgA in NEPC
Studies have shown
- CgA indicates neuroendocrine differentiation (NED) in prostate cancer7
- CgA values are associated with tumor stage, therapy response and clinical outcome8,9,10
- CgA supports identification of emerging resistance to hormonal therapy6,9
- Elevated CgA indicates development of metastases and risk for aggresive prostate cancer10,11
Discover the benefits of CgA as a biomarker for prostate cancer
Offering a key indicator for risk and treatment resistance
PSA is the most important biomarker to monitor prostate cancer patients. However, NEPC cells secrete no or only low amounts of PSA. Nevertheless, CgA is expressed by NEPC cells and secreted directly into circulation.5,7 This leads to an increase of CgA levels in blood which could indicate NEPC earlier than PSA alone.
NEPC cells can grow independently from androgens. Consequently, standard androgen deprivation therapies are no longer effective against these cancer cells. CgA aids in earlier identification of emerging resistance to hormonal therapy because of simple detection in the blood.6,9
Patients with ADT-resistant prostate cancer must change to either advanced hormonal treatments, such as Abiraterone or enzalutamide, or chemotherapy. CgA values facilitate therapy response and help inform therapy decisions.8,9,10
Because neuroendocrine cells typically do not express PSA, it has limited use in monitoring NEPC. In contrast, these cells do express CgA, which correlates with tumor stage and disease progression, providing important additional information to urologists and oncologists.7
As a result of better guidance for treatment and more confidence in NEPC monitoring, CgA improves the overall care urologists and oncologists provides to patients.7,8,10,11
CgA assay now included in German guidelines on prostate cancer
The inclusion of the CgA assay in the updated German guidelines on Prostate Cancer management12 reflects the growing recognition of its clinical relevance in the management of this disease. Recent publications support the inclusion of these new recommendations.8,13
By incorporating the CgA assay into the guidelines, German healthcare professionals will have another officially recognized tool to aid in treatment decision-making for patients with neuroendocrine prostate cancer. This development reinforces the importance of staying up to date with the latest guidelines and advancements in the field of oncology/urology.
Expert insights on using CgA as a tool in therapy monitoring of prostate cancer patients
Helpful resources
Monitor Chromogranin A levels in neuroendocrine tumor patients with ease and confidence
Thermo Scientific B·R·A·H·M·S CgA II KRYPTOR is the first FDA-cleared, automated immunofluorescent assay for the quantitative determination of the concentration of Chromogranin A in human serum. The biomarker is to be used in conjunction with other clinical methods as an aid in monitoring disease progression during the course of disease and treatment in patients with GEP-NETs, grade 1 and grade 2.
Clinical evidence: CASPAR (Chromogranin A Surveillance biomarker in Patients with Carcinoids)
A prospective, multi-center, observational study with 153 evaluable neuroendocrine tumor patients was performed to validate the performance of B·R·A·H·M·S CgA II KRYPTOR Assay in monitoring grade 1 and grade 2 GEP-NET progressive or non-progressive disease within 32 months.
Course of disease was assessed by standard imaging (CT/MRI scans) and tumors were classified by RECIST 1.1 criteria for progression (progressive disease) vs. no progression (complete response, partial response or stable disease). The change in CgA levels between visits was considered positive if the CgA concentration increased by more than 50% to an absolute value of >100 ng/ml.
Short incubation time and less dilutions using the B·R·A·H·M·S KRYPTOR Analyzer for CgA assays14
Incubation time (min) of various CgA assays
Ratio of samples that require dilution in a representative clinical setting
References:
A comprehensive summary of performance can be found in the Instructions for Use for each assay or in the User Manual of your B·R·A·H·M·S KRYPTOR instrument.
- Globocan 2022 Graph production: Global Cancer Observatory (https://gco.iarc.fr).
- Dong, B., et al., Prostate, 2017. 77(13): p. 1373 –1380.
- Fan, L., et al., BJU Int, 2017. 120(2): p. 226 – 232.
- Liede, A., et al., ESMO Open, 2016. 1(2): p. e000040.
- Beltran, H., et al., Cancer Discov, 2011. 1(6): p. 487–95.
- Tarle, M., M.Z. Ahel, and K. Kovacic, Anticancer Res, 2002. 22(4): p. 2525–9.
- Tritschler, S., et al., Pathologe, 2018. 39(4): p. 333–343.
- Szarvas, T., et al., BJU Int, 2021. 127(1): p. 44-55.
- Berruti, A., et al., J Urol, 2007. 178(3 Pt 1): p. 838-43; quiz 1129.
- Hirano, D., et al., Scand J Urol Nephrol, 2007. 41(4): p. 297–301.2.
- Sciarra, A., et al., Urol Int, 2009. 82(2): p. 147–51.
- S3 - Leitlinie Prostatakarzinom - Mai 2024.
- Ploussard G., et al., World J Urol, 2023. 41(2):361-369.
- Inman, Z. et al., Automated Chromogranin A: is KRYPTOR the way to go?, AACB Meeting 2012 Melbourne, Poster P85.
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