Noninvasive biomarkers to guide intervention: toward personalized patient management in prostate cancer

ABSTRACT

Introduction

Prostate cancer (PCa) is one of the most frequently diagnosed malignancies worldwide and is associated with high mortality. Broad screening through prostate-specific antigen analysis, along with an aging and growing population has resulted in a vast increase in PCa incidence. As not all PCa forms are life threatening, personalized management is of paramount importance to preserve survival and quality of life for the diagnosed patients. Owing to the complexity of PCa, noninvasive biomarkers for diagnosis, stratification and monitoring, are essential to tailor intervention among patients with different disease manifestations.

Areas covered

In this article, we aim to provide a critical assessment of the reported noninvasive biomarkers for PCa and their applicability according to the targeted clinical context. For this purpose, a systematic review of the literature published within the last five years was performed, focusing on noninvasive biomarkers to guide initial and repeated biopsies, stratify for active surveillance, monitor biochemical recurrence and metastasis, and adjust treatment for metastatic castration resistant PCa.

Expert’s opinion

Evidence from clinical trials on novel drugs and latest technological advancements, indicate several clinical applications for biomarkers to tailor intervention throughout PCa progression, toward a more personalized medicine approach in PCa clinical management.

KEYWORDS:

• Active surveillance
• biomarkers
• diagnosis
• prostate cancer
• treatment prediction

Article highlights

1. Because of the complexity of PCa clinical presentation, accurate non-invasive biomarkers for screening, diagnosis and monitoring are expected to reduce unnecessary biopsies, overdiagnosis and overtreatment, and guide optimal personalized intervention.

2. Recently developed -omics technologies enable high-throughput analyses and provide the possibility to obtain large high-resolution datasets.

3. High disease heterogeneity could be overcome by combination of biomarkers into multiparametric panels in combination with clinical and/or imaging variables.

4. Recent urine-based biomarker reports focus on less advanced cancer, with targeted applications for initial cancer diagnosis, guidance of first and repeated biopsies and monitoring PCa patients during active surveillance.

5. Recently validated studies on serum-based biomarkers demonstrate potential applicability for the management of localised PCa with promising data also on prediction of response to second line abiraterone/enzalutamide or taxane chemotherapy.

6. Successful clinical implementation of non-invasive biomarkers requires independent validation in large prospective trials to demonstrate added value over clinical standard tools.

Declaration of interest

MF is employed by Mosaiques Diagnostics GmbH. HM is the founder and co-owner of Mosaiques Diagnostics GmbH. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Supplemental Material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was supported by the BioGuidePCa (E! 11023, Eurostars) funded by Bundesministerium für Bildung und Forschung (BMBF) in Germany.