Abstract
Prostate cancer (PCa) incidence is increasing due to the ageing worldwide population. In recent years, the unsuitability of prostate specific antigen (PSA) as a diagnostic biomarker has become apparent. Unnecessary treatment of men with non-lethal disease leading to significant quality-of-life reducing side-effects resulted in 2017 in the US Preventative Services Task Force (USPSTF) recommending selective and limited use of PSA testing for PCa. An immediate need exists for a test capable of accurate and early diagnosis of PCa. Critically, this test must differentiate between indolent and aggressive PCa to inform appropriate management of the disease. The key to predictive accuracy is the utilisation of combinations of diverse biomarkers and clinical data. A number of suitable new tests have emerged since 2013 but none of these have been implemented in the clinical setting. Extensive clinical validation of these tests is critical to address the chasm that now exists in PCa diagnostics. This mini review assesses current clinical issues for PCa diagnosis, evaluates currently available commercial tests and critically assesses next-generation diagnostic tools that could revolutionise PCa diagnostics.
Highlights
Prostate cancer (PCa) was first described in the 19th century by J
Extensive clinical validation of these tests is critical to address the chasm that exists in PCa diagnostics
Survival is directly related to stage-at-diagnosis and investing in disruptive and effective diagnostic tools would lead to a reduction in mortality
Summary
Prostate cancer (PCa) was first described in the 19th century by J. Sharma et al (2017) reviewed 13 novel multifactorial assays[10] These tests utilise an array of biomarkers including PSA isoforms, metabolites, kallikrein protein biomarkers, T2:ERG gene fusion and exosomal RNA alongside clinical data such as age, DRE and prior biopsy results from test specimens including serum, urine and tissue (Table 3). STHLM3 is an example of the precise type of new diagnostic test needed to replace the currently existing methods of PCa diagnosis It demonstrates the effectiveness of combining different types of biomarkers with clinical data. Autoantibodies, produced in response to tumourassociated antigens, are promising biomarkers due to their immediate presence following any perturbation to the cellular microenvironment of the prostate gland They represent ideal candidates for early detection of PCa which is critical to ensure positive patient outcomes.
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