Chapter 37 - Genomic Evaluation and Management of Prostate Cancer

Abstract

Prostate cancer is the second leading cause of cancer death in men living in Western countries. This chapter highlights prostate cancer discoveries empowered by the nascent ability to perform global analysis on DNA variation, RNA expression, and protein expression. The management of men diagnosed with prostate cancer remains predicated on a combination of the clinical and pathological characteristics of the individual, and the cancer. The dramatic response of metastatic prostate cancer to castration demonstrates the profound impact and increasing insight of successful molecularly targeted therapy into the molecular pathogenesis of prostate cancer, holding further therapeutic promise. The genetic and epigenetic events that result in the transformation of prostate epithelial cells are becoming better understood and genomic tools have fueled many of the recent discoveries. The discovery of circulating prostate-specific antigen (PSA) and its subsequent use as a screening test has resulted in earlier detection, but PSA screening has yet to demonstrate a survival benefit. While PSA can diagnose prostate cancer earlier than symptoms, physical exam, or other blood chemistries, it remains limited as a predictive marker and provides little insight as to the specific biology of an individual's prostate cancer. The goal of many genomic projects in prostate cancer is to improve upon the specificity of serum PSA and develop biomarkers that provide additional predictive or biological insight.