Profiling prostate cancer

Abstract

Among men worldwide, prostate cancer has become the second most frequently diagnosed cancer and the sixth leading cause of cancer death, accounting for 240,890 new diagnoses and 33,720 deaths in the United States alone in 2011 (1, 2). Fortunately, with wide use of prostate cancer screening, early detection, and definitive local therapy, prostate cancer mortality rates have been falling in the United States—as much as 39% or more since 1990 (2). Nonetheless, randomized clinical trials of serum prostate-specific antigen (PSA) testing for prostate cancer screening have suggested that these gains have come at a significant cost: by one estimate, to save a single life from prostate cancer death, 1,410 men need to be screened, and 48 cases of prostate cancer need to be diagnosed and treated (3). On October 11, 2011, the US Preventive Services Task Force issued a draft report on PSA screening, assigning the practice a grade D recommendation and weighing in “against the service” because of “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” The firestorm of controversy triggered by this report highlights (i) the need for individualized approaches to prostate cancer screening at a population scale, so that screening services can be targeted in such a way as to minimize overdiagnosis, and (ii) the need to personalize treatment decisions, so that options like the use of active surveillance in lieu of definitive local therapy can be rationally selected in such a way as to reduce overtreatment (4, 5). In PNAS, Markert et al. (6) attempt to address these needs through the discovery of new molecular biomarkers for aggressive prostate cancer.