Prostate cancer biomarkers: a practical review based on different clinical scenarios

Abstract

Traditionally, diagnosis and staging of prostate cancer (PCa) have been based on prostate-specific antigen (PSA) level, digital rectal examination (DRE), and transrectal ultrasound (TRUS) guided prostate biopsy. Biomarkers have been introduced into clinical practice to reduce the overdiagnosis and overtreatment of low-grade PCa and increase the success of personalized therapies for high-grade and high-stage PCa. The purpose of this review was to describe available PCa biomarkers and examine their use in clinical practice. A nonsystematic literature review was performed using PubMed and Scopus to retrieve papers related to PCa biomarkers. In addition, we manually searched websites of major urological associations for PCa guidelines to evaluate available evidence and recommendations on the role of biomarkers and their potential contribution to PCa decision-making. In addition to PSA and its derivates, thirteen blood, urine, and tissue biomarkers are mentioned in various PCa guidelines. Retrospective studies have shown their utility in three main clinical scenarios: (1) deciding whether to perform a biopsy, (2) distinguishing patients who require active treatment from those who can benefit from active surveillance, and (3) defining a subset of high-risk PCa patients who can benefit from additional therapies after RP. Several validated PCa biomarkers have become commercially available in recent years. Guidelines now recommend offering these tests in situations in which the assay result, when considered in combination with routine clinical factors, is likely to affect management. However, the lack of direct comparisons and the unproven benefits, in terms of long-term survival and cost-effectiveness, prevent these biomarkers from being integrated into routine clinical use.

Keywords:

• Prostate cancer
• screening
• radical prostatectomy
• adjuvant therapy
• biomarkers

Authors’ contribution

Research conception and design: Ugo Giovanni Falagario, Riccardo Autorino, and Luigi Cormio

Data acquisition: Ugo Giovanni Falagario, Umberto Carbonara, Fabio Crocerossa, and Antonella Ninivaggi

Data analysis and interpretation: Riccardo Autorino, Ugo Giovanni Falagario, and Ivan Jambor

Drafting of the manuscript: Ugo Giovanni Falagario, Francesca Sanguedolce, Zach Dovey, George Papastefanou, and Ivan Jambor.

Critical revision of the manuscript: Riccardo Autorino, Giuseppe Carrieri, Luigi Cormio, Ivan Jambor, Anna Lantz, Umberto Carbonara, and Fabio Crocerossa

Supervision: Riccardo Autorino, Giuseppe Carrieri, and Luigi Cormio

Approval of the final manuscript: All authors.

Disclosure statement

No potential conflict of interest was reported by the author(s).