Abstract
Worldwide, prostate cancer (PC) is the second-most-frequently diagnosed male cancer and the fifth-most-common cause of all cancer-related deaths. Suspicion of PC in a patient is largely based upon clinical signs and the use of prostate-specific antigen (PSA) levels. Although PSA levels have been criticised for a lack of specificity, leading to PC over-diagnosis, it is still the most commonly used biomarker in PC management. Unfortunately, PC is extremely heterogeneous, and it can be difficult to stratify patients whose tumours are unlikely to progress from those that are aggressive and require treatment intensification. Although PC-specific biomarker research has previously focused on disease diagnosis, there is an unmet clinical need for novel prognostic, predictive and treatment response biomarkers that can be used to provide a precision medicine approach to PC management. In particular, the identification of biomarkers at the time of screening/diagnosis that can provide an indication of disease aggressiveness is perhaps the greatest current unmet clinical need in PC management. Largely through advances in genomic and proteomic techniques, exciting pre-clinical and clinical research is continuing to identify potential tissue, blood and urine-based PC-specific biomarkers that may in the future supplement or replace current standard practices. In this review, we describe how PC-specific biomarker research is progressing, including the evolution of PSA-based tests and those novel assays that have gained clinical approval. We also describe alternative diagnostic biomarkers to PSA, in addition to biomarkers that can predict PC aggressiveness and biomarkers that can predict response to certain therapies. We believe that novel biomarker research has the potential to make significant improvements to the clinical management of this disease in the near future.
Highlights
When this occurs in the absence of any metastatic disease, it is known as non-metastatic castrateresistant prostate cancer
While the majority of data for Poly (adenosine diphosphate [ADP]–ribose) polymerase (PARP) inhibitors has been generated for metastatic castrate-resistant prostate cancer (mCRPC) patients, there will be interest among the scientific and clinical communities on the results of studies concentrating on earlier disease stages
The widespread use of prostate-specific antigen (PSA) levels for prostate cancer (PC) diagnosis and management led to criticisms of over-diagnosing and over-treating patients, its use undoubtedly paved the way for investigations into more specific PC biomarkers
Summary
(iii) The assessment of prostate specific antigen (PSA) levels Together, this information is used to determine whether a patient is within a low-, intermediate- or high-risk group [7]. Due to the significant complications associated with definitive treatment, the identification of biomarkers at the time of screening/diagnosis that provide an indication of the risk of aggressiveness is perhaps currently the greatest unmet clinical need in PC management. 7; BCR, biochemical recurrence; CTCs, circulating tumour cells; CTLA-4, cytotoxic T lymphocyte-associated protein-4; miRNA, microRNAs; PARP, poly (ADP-ribose) polymerase; PC, prostate cancer; PD-1, programmed death-1; PORTOS, Post-Operative Radiation Therapy Outcomes Score; PTEN, phosphatase and tensin homolog; RP, radical prostatectomy; RT, radiotherapy; sncRNAs, small non-coding RNAs; TMB, Tumour mutational burden. Separates patients that have PC from those with a true negative biopsy result, tumour grade
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