PTEN Testing Strategies for Newly Diagnosed mHSPC

In this video, Scott Sellinger, MD, FACS, discusses how PTEN testing may become increasingly integrated into the routine evaluation of patients with newly diagnosed metastatic prostate cancer following the FDA approval of capivasertib (Truqap) for patients with PTEN-deficient disease identified by an FDA-authorized test. He explains that many clinicians already incorporated PTEN testing because of its established role as a prognostic biomarker, but the availability of a targeted therapy now increases the importance of identifying patients with PTEN loss early in their disease course.

Sellinger highlights immunohistochemistry (IHC) as an important method for detecting PTEN deficiency, explaining that it allows pathologists to directly assess PTEN protein expression and determine the degree of loss within tumor tissue. While next-generation sequencing (NGS) can identify some patients with PTEN alterations, he notes that IHC may capture a broader group of patients with PTEN loss. He adds that IHC can often be incorporated alongside existing genomic testing workflows, with relatively short turnaround times and minimal additional cost, making it a practical option for many clinical settings.

Discussing implementation in community urology practices, Sellinger explains that PTEN IHC testing will likely require collaboration with reference laboratories in many settings, although larger integrated health systems may have the infrastructure to perform testing internally. He emphasizes that PTEN evaluation should occur as early as possible after metastatic disease is identified, aligning with guideline recommendations for comprehensive molecular evaluation, including germline and somatic testing. Early identification of PTEN deficiency allows clinicians to better characterize disease biology and determine which patients may benefit from targeted approaches.