Improving the Nuclear-Localized Androgen Receptor Splice Variant 7 Test—In Reply

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In Reply Nicolazzo and colleagues suggest that the use of confocal microscopy would improve the technical and clinical accuracy of the androgen receptor splice variant 7 (AR-V7) diagnostic test. It is hypothesized that limitations (unspecified) of the widefield optics limit the ability to determine the 3-dimensional cellular organization and the localization of protein. Although confocal microscopy is a suitable research tool for evaluating the subcellular localization of organelles and proteins, it is impractical for this application in the clinical setting and is redundant for accurately determining protein localization. As evidenced by our studies to date, the specificity of the test to determine a poor outcome if a patient is treated with androgen receptor signaling inhibitors is extremely high, a finding independently corroborated in a separate cohort and in the PROPHECY study presented at the 2018 annual meeting of the American Society of Clinical Oncology.

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