New Molecular Markers of Diagnosis and Prognosis in Prostate Cancer

Abstract

Serum prostate-specific antigen (PSA) has remained the mainstay biomarker for prostate cancer diagnosis and management since its wide spread utilization as a screening tool almost 25 years ago. Although it has led to a dramatic increase in prostate cancer detection, PSA has substantial drawbacks both with sensitivity and specificity. Detection of clinically insignificant disease is another important issue. Together, these drawbacks of PSA emphasize the need for biomarkers that can supplement PSA as a diagnostic test, provide better cancer specificity than currently available tissue-based markers, reduce the number of unnecessary biopsies, and distinguish indolent from clinically significant prostate cancer. New genomic and bioinformatics technologies have allowed the discovery and study of an expanding universe of novel tissue-, urine-, or body fluid-based biomarkers due to their higher cancer specificity and their prognostic or predictive utilities. Such efforts have also produced several notable success stories that involve rapidly moving biomarkers from the bench to the clinic. α-Methylacyl-CoA racemase (AMACR), ERG fusion protein, phosphatase and tensin homolog (PTEN), and prostate cancer antigen 3 (PCA3) are important examples of biomarkers, which have found their way from bench to clinic. This chapter summarizes selected novel promising prostate cancer biomarkers of utility for the diagnosis, biological stratification, and prognosis of prostate cancer. The biomarkers addressed in the chapter are classified based on their diagnostic and prognostic applications as well as their functions as tissue- and urine-based markers.