An evaluation of current prostate cancer diagnostic approaches with emphasis on liquid biopsies and prostate cancer

ABSTRACT

Introduction: Knowledge of the complex biology of prostate cancer is constantly growing, opening the field up to new therapeutic advances. The selection of patients on the basis of prognostic and predictive biomarkers is a challenging and emerging clinical need, not yet completely fulfilled. In this scenario, liquid biopsy offers a noninvasive and attractive approach to give important information about tumor biology and eventual resistance to treatments.

Areas covered: The aim of this review of the literature is to evaluate the current knowledge and the promising value of liquid biopsy in prostate cancer. Circulating tumor cells and circulating tumor DNA identified by liquid biopsies are currently under evaluation to guide therapeutic decisions in prostate cancer management, even though practical applications of these approaches are still very limited. We examined the current areas of interest in which circulating tumor cells and circulating tumor DNA are being investigated, such as their prognostic and predictive role in response to chemotherapy or androgen receptor signaling inhibition, especially in the castration-resistant setting.

Expert opinion: As the body of knowledge on liquid biopsy rapidly grows, we need to identify which can be the real applications of this technique in clinical practice and to overcome the problems that are limiting its routinely use.

KEYWORDS:

• Cell free DNA (cfDNA)
• circulating tumor cell (CTC)
• circulating tumor DNA (ctDNA)
• castration resistant prostate cancer
• liquid biopsy
• prostate cancer

Article Highlights

• The rationale for liquid biopsy lies in the growing understanding of the complex biology of prostate cancer. Multiple genetic alteration can be identified in different stages of the diseases. The main genetic mutations with prognostic or therapeutic implications are discussed.

• Circulating tumor cells (CTCs) are nucleated tumor cells in peripheral blood deriving from primary tumor or metastatic sites. The main studies investigating the prognostic or predictive role of CTCs are examined.

• Circulating tumor DNA (ctDNA) is genetic material released by tumor cells into the bloodstream harboring the mutations of the original tumor. This can be a prognostic and predictive biomarker as well since it reproduces genomic alterations carried by the solid tumor from which it derives.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers Disclosure

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

Additional information

Funding

This paper was not funded.