madman
Super Moderator
Prostate-specific antigen (PSA) is one of the best-known biomarkers for screening, diagnosis, and follow-up of patients for prostate cancer. Owing to several inherent limitations with PSA, various newer blood and urinary-based biomarkers have been evaluated in pursuit of better detection and risk stratification of prostate cancer cases. A combination of these different markers, in adjunct with clinical risk factors, and recent advances in imaging promises to offer better diagnostic performance with clearer risk stratification guiding therapeutics. We carried out an extensive literature search for the different biomarkers available for screening and diagnosis of prostate cancer, compared their performance with serum PSA to allow clinicians to draw meaningful conclusions to offer their patients more personalized medical care.
INTRODUCTION
The discovery of prostate-specific antigen (PSA) has undoubtedly been one of the most important turning points in history for the diagnosis and management of prostate cancer. The introduction of this novel biomarker in the late 1980s brought about a paradigm shift in the diagnosis of prostate cancers, with a sudden increase in the incidence of the disease, accompanied by a noteworthy stage migration; this resulted in improved survival for patients with prostate cancer
Not to undermine the importance of the most widely used biomarker for screening, diagnosis, and follow-up of any solid tumor, there are controversies regarding the use of PSA in prostate cancer screening. These stem from the fact that using PSA as a screening tool saw an increase in detection of several indolent tumors, and subsequent “over-treatment” with radical treatment for these cancers, which probably would have never surfaced in the lifetime of the patient without screening. Additionally, the lack of specificity for cancer and lack of a true prognostic ability has pushed several researchers to look beyond PSA for newer markers with better sensitivity and specificity, as well as prognostic calibration for screening and diagnosing patients harboring clinically significant prostate cancer. This review looks at various blood and urine-based markers available for screening prostate cancer and how they perform in comparison to PSA.
*PROSTATE SPECIFIC ANTIGEN FOR SCREENING OF PROSTATE CANCER: CONTROVERSIES AND RECOMMENDATIONS
*BLOOD-BASED MARKERS
1. Free prostate-specific antigen
2. Prostate Health Index
3. 4K score
*URINE BASED MARKERS
1. Prostate cancer antigen 3
2. TMPRSS2:ERG fusion
3. Urinary mRNA (SelectMDx®)
*IMAGING AS A SCREENING TOOL: MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING
CONCLUSIONS
PSA, in spite of its inherent shortcomings, has been and continues to be, the gold standard screening biomarker for prostate cancer. Advancements in the fields of genomic and proteomic technologies have enabled us to decipher the genetic basis and true biology of prostate cancers and make major advancements in the fields of diagnosis and therapeutics. Several newer biomarkers, be it the different isoforms of PSA or gene-based markers, have come to the forefront with better diagnostic and prognostic performance than PSA. A combination of these biomarkers promises to offer the best in diagnostics and comes closest to being an ideal biomarker. Several assays combining these individual biomarkers are already available, but large, multicenter studies are needed to establish the true performance of these assays and their acceptance as the screening method of choice over the standard PSA. mpMRI is also emerging as a promising tool to detect lesions early and screen patients for prostate cancer. A combination of imaging along with other blood and urine-based biomarkers has the potential to have the highest sensitivity and specificity and to detect the most clinically significant prostate cancer. This would not only improve the diagnostics but also guide the therapeutics of prostate cancer, enabling urologists to make a more informed decision regarding surveillance and radical treatment. Until such time, serum PSA continues to be the most widely accepted biomarker for prostate cancer screening.
INTRODUCTION
The discovery of prostate-specific antigen (PSA) has undoubtedly been one of the most important turning points in history for the diagnosis and management of prostate cancer. The introduction of this novel biomarker in the late 1980s brought about a paradigm shift in the diagnosis of prostate cancers, with a sudden increase in the incidence of the disease, accompanied by a noteworthy stage migration; this resulted in improved survival for patients with prostate cancer
Not to undermine the importance of the most widely used biomarker for screening, diagnosis, and follow-up of any solid tumor, there are controversies regarding the use of PSA in prostate cancer screening. These stem from the fact that using PSA as a screening tool saw an increase in detection of several indolent tumors, and subsequent “over-treatment” with radical treatment for these cancers, which probably would have never surfaced in the lifetime of the patient without screening. Additionally, the lack of specificity for cancer and lack of a true prognostic ability has pushed several researchers to look beyond PSA for newer markers with better sensitivity and specificity, as well as prognostic calibration for screening and diagnosing patients harboring clinically significant prostate cancer. This review looks at various blood and urine-based markers available for screening prostate cancer and how they perform in comparison to PSA.
*PROSTATE SPECIFIC ANTIGEN FOR SCREENING OF PROSTATE CANCER: CONTROVERSIES AND RECOMMENDATIONS
*BLOOD-BASED MARKERS
1. Free prostate-specific antigen
2. Prostate Health Index
3. 4K score
*URINE BASED MARKERS
1. Prostate cancer antigen 3
2. TMPRSS2:ERG fusion
3. Urinary mRNA (SelectMDx®)
*IMAGING AS A SCREENING TOOL: MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING
CONCLUSIONS
PSA, in spite of its inherent shortcomings, has been and continues to be, the gold standard screening biomarker for prostate cancer. Advancements in the fields of genomic and proteomic technologies have enabled us to decipher the genetic basis and true biology of prostate cancers and make major advancements in the fields of diagnosis and therapeutics. Several newer biomarkers, be it the different isoforms of PSA or gene-based markers, have come to the forefront with better diagnostic and prognostic performance than PSA. A combination of these biomarkers promises to offer the best in diagnostics and comes closest to being an ideal biomarker. Several assays combining these individual biomarkers are already available, but large, multicenter studies are needed to establish the true performance of these assays and their acceptance as the screening method of choice over the standard PSA. mpMRI is also emerging as a promising tool to detect lesions early and screen patients for prostate cancer. A combination of imaging along with other blood and urine-based biomarkers has the potential to have the highest sensitivity and specificity and to detect the most clinically significant prostate cancer. This would not only improve the diagnostics but also guide the therapeutics of prostate cancer, enabling urologists to make a more informed decision regarding surveillance and radical treatment. Until such time, serum PSA continues to be the most widely accepted biomarker for prostate cancer screening.
