Abstract
The application of prostate-specific antigen (PSA) in prostate cancer (PC) screening, diagnosis, and prognosis has improved the clinical management of PC patients. However, the PSA assay has been faced with criticism due to its potential association with over-diagnosis and subsequent overtreatment of patients with indolent disease. The United States Preventive Services Task Force incited much debate over PSA-based screening in 2012 by recommending against this approach. However, the PSA assay remains the first-line tool for the early detection of PC. This debate highlights the unmet need for non-invasive PC biomarkers with greater sensitivity and specificity that are capable of distinguishing aggressive disease from indolent disease, predicting treatment response, and guiding treatment decisions. Recent investigations into putative PC biomarkers have focused on PSA isoform assays (prostate health index, 4-kallikurein panel), PC-associated genes in the urine (PCA3 and TMPRSS2-ERG), glycan-associated biomarkers (S2, 3PSA, GCNT1, and tri- and tetra-antennary serum N-glycans), and circulating tumor cells. Although substantial efforts to identify novel PC biomarkers that might replace PSA have been put forth, the majority of the putative PC biomarkers reported in the last few years are still under investigation or validation. This review provides an overview of the current state of PC biomarker research and focuses on a few promising PC biomarkers in development.
Highlights
In 2015, prostate cancer (PC) was the most commonly diagnosed male malignancy, in western countries [1], and in Japan [2]
Several studies have suggested that prostate health index (PHI) significantly improves prostate cancer detection in high-risk cases [11, 13] and that is associated with PC aggressiveness [12]
The longitudinal follow-up of highly branched N-glycan levels predicted castrationresistant PC (CRPC) despite castrate levels of testosterone. These results suggest that the overexpression of specific N-glycans might be associated with CRPC and that it might represent a predictive CRPC biomarker
Summary
In 2015, prostate cancer (PC) was the most commonly diagnosed male malignancy, in western countries [1], and in Japan [2]. Several studies have suggested that PHI significantly improves prostate cancer detection in high-risk cases [11, 13] and that is associated with PC aggressiveness [12]. Retrospective studies reported that the 4K score was more accurate in predicting clinically diagnosed PC [14] and aggressive disease [15] compared with PSA and age.
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