Strategies for Using Biomarkers in Prostate Cancer

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In prostate cancer, as in many other types of cancer, the identification and utilization of biomarkers is an integral part of diagnosis and treatment. However, despite many biomarkers existing in the prostate cancer setting, their current clinical application is limited.

In thinking about available biomarkers in prostate cancer, Neal D. Shore, MD, suggests that biomarkers can be utilized to determine which patients should be biopsied and which require a second biopsy, if the first test is negative. Additionally, biomarkers can be utilized to better stratify risk and make treatment decisions for newly diagnosed patients; ultimately, deciding between an interventional and a noninterventional therapy. Biomarkers can also be instrumental in monitoring patients who are receiving treatment or active surveillance, Raoul S. Concepcion, MD, adds.

In addition to a discussion on the more widely known biomarkers, such as PSA, free PSA, and PSA-3, Ganesh S. Palapattu, MD, describes the Michigan Prostate Score (MiPS), which combines serum PSA, urine TMPRSS2:ERG, and urine PCA-3 to predict a patient’s risk of having prostate cancer detected by standard biopsy. Unlike most currently available biomarkers, MiPS can not only detect prostate cancer but also predict the patient’s risk of having potentially aggressive prostate cancer.

Along with the MiPS, other indices such as the 4K-Score and the Prostate Health Index have been useful for directing care of men with prostate cancer. Still, many of these tests have not been validated across diverse cohorts of patients, and must continue to be included as a part of a patient’s comprehensive medical review.