Molecular markers to guide primary radical treatment selection in localized prostate cancer

Localized prostate cancer can be effectively treated by surgical or radiotherapy approaches. In selected cases, active surveillance may also be appropriate. The choice of therapy for an individual is dependent on a number of factors but it is well recognized that different therapies may work equally well. Conversely, many patients will fail a particular treatment despite apparently favorable disease characteristics. A priori knowledge of how a tumor will respond to a treatment would be a powerful tool toward tailored therapy. Very little attention has been paid to the role of biomarkers in predicting therapy-specific responses. In this article, the current evidence for the use of tissue biomarkers to guide radical therapy selection in localized prostate cancer is discussed. Treatment failure mechanisms and the future design of research are also considered with regard to how they might inform biomarker discovery and validation in this important area of clinical need.