Personalised Patient Diagnosis and Prognosis in Prostate Cancer: What Are the Future Perspectives?

ContextWith the advent of prostate-specific antigen (PSA) screening, prostate cancer (PCa) is being diagnosed at an earlier disease stage, and more patients are potentially being overtreated.ObjectiveThis review looks at the occurrence of insignificant/indolent PCa and these cancers’ distinction from more serious forms of the disease through the use of biomarkers.Evidence acquisitionDuring the 2010 Annual Congress of the European Association of Urology in Barcelona, Spain, a satellite symposium was held on the individualised management of patients with PCa. This paper is based on one of the presentations at the symposium. Data were retrieved from recent review articles, original articles, and abstracts on indolent PCa and biomarkers.Evidence synthesisThe Epstein criteria are the most widely used predictors of clinically insignificant PCa and have been validated in studies in the United States and Europe. Further progress has been made through the development of prognostic models or nomograms, the most widely known of which are the Kattan nomograms, with a predictive probability for indolent cancer of 64–79%. Additional predictive biomarkers that have been researched include PCa gene 3 (PCA3), a noncoding, prostate-specific mRNA that is highly overexpressed in PCa tissue compared with benign tissue and correlates with tumour aggressiveness. Other advances involve the identification of gene fusions, particularly TMPRSS2:ERG, which is present in up to 50% of PCa cases, and the use of circulating tumour cell (CTC) counts, which have been shown to correlate with prognosis in castration-resistant PCa (CRPC).ConclusionsBiomarkers such as PCA3, TMPRSS2:ERG and CTC provide a new vision in the management of patients with PCa. They will be useful in routine practice and help to provide more personalised therapeutic alternatives to individual patients.