Beyond PSA: utility of novel tumor markers in the setting of elevated PSA

The introduction of prostate-specific antigen (PSA) for prostate cancer screening and detection has been used for over 20 years and has dramatically changed the face of prostate cancer. Although it is a highly sensitive serum test, its routine use has been the subject of continued controversy owing to its limited specificity. Due to this lack of specificity, many have proposed modifications of PSA in an attempt to bolster the performance of this analyte. The human genome project and high throughput gene expression profiling has recently yielded several promising molecular biomarkers for prostate cancer detection beyond PSA or PSA modifications. This review will first highlight several characteristics of an ideal biomarker, then focus on select emerging biomarkers for the detection of prostate cancer.