Predicting high risk disease using serum and DNA biomarkers.

PURPOSE OF REVIEW

To explore several serum and genetic-based biomarkers that may prove useful in following men being managed with active surveillance for localized prostate cancer by predicting those that either have the potential to develop, or already harbor occult high grade disease.

RECENT FINDINGS

There is increasing evidence that serum biomarkers human Kallikrein 2, early prostate cancer antigen, urokinase-type plasminogen activator/urokinase-type plasminogen activator receptor, transforming growth factor-β1 and interleukin-6/interleukin-6 receptor and genetic biomarkers BRCA1 and BRCA2, Phosphatase and tensin homolog, cellular myelocytomatosis oncogene and NKX3.1 may predict for aggressive high grade disease and are identifiable early in prostate carcinogenesis.

SUMMARY

One of the barriers of widespread adoption of active surveillance for low risk, localized prostate cancer is the concern that some patients may harbor occult high-risk disease at diagnosis, or develop more aggressive/noncurable disease not detected by our current well established prognostic factors. This review examines several serum and genetic-based biomarkers that appear to be of value in localized prostate cancer, unlike the vast majority of more established prostate cancer biomarkers that have been validated in far more advanced disease. Although the biomarkers discussed show exciting promise, their clinical utility is unknown, and their role in the active surveillance scenario needs further study.