Joshua Lang, MD, MS, on integrating molecular biomarkers into clinical practice

In the following interview, conducted at the 2026 American Society of Clinical Oncology Annual Meeting, Joshua Lang, MD, MS, discusses the evolving role of molecular biomarkers in guiding treatment selection for patients with advanced prostate cancer and the challenges of integrating precision oncology into routine clinical practice. Lang is a medical oncologist at the University of Wisconsin Carbone Cancer Center.

Over the past decade, significant advances in systemic therapies have expanded treatment options for patients with locally advanced and metastatic prostate cancer, but determining which patients are most likely to benefit from treatment intensification remains a major challenge, according to Lang. He noted that clinicians also need better tools to identify patients who may safely avoid additional therapies, such as chemotherapy, without compromising outcomes. Developing reliable biomarkers that can distinguish which patients require escalation or de-escalation of treatment is essential to achieving a more personalized approach to care.

Lang emphasized that incorporating precision oncology into everyday practice extends beyond identifying molecular alterations and requires understanding how those biomarkers translate to treatment decisions for individual patients. He highlighted the importance of germline and somatic testing for homologous recombination repair gene mutations, such as BRCA2, particularly in patients with newly diagnosed metastatic or locally advanced disease, both to inform therapy and identify hereditary cancer risk for family members. However, integrating this growing volume of molecular information into multidisciplinary clinical workflows remains a challenge for urologists, medical oncologists, and radiation oncologists.

Looking ahead, Lang pointed to transcriptomic profiling as an emerging tool that may provide additional insight into tumor biology by identifying cancers with aggressive features, such as high proliferative activity, that could benefit from treatment intensification. Although recent data evaluating biomarker-driven strategies—including the use of PARP inhibitors in patients with BRCA1/2-mutated disease—are promising, he stressed that additional prospective validation is needed before these assays can be routinely used to guide first-line treatment decisions. Ultimately, he said, the goal is to develop clinically validated biomarkers that provide actionable information through a single test, making precision oncology more practical in everyday care.