Active Surveillance in Prostate Cancer: Current and Potentially Emerging Biomarkers for Patient Selection Criteria

Area of Science:

• Oncology
• Biomarker Discovery
• Urology

Background:

• Prostate cancer (PCa) is a leading cause of cancer death in men, with early detection increasing survival.
• Many diagnosed PCa cases are low-risk, yet often receive aggressive treatments causing side effects and high costs.
• Active surveillance (AS) offers an alternative for low-risk PCa, but accurate patient selection at diagnosis is challenging, necessitating effective prognostic biomarkers.

Purpose of the Study:

• To review current and emerging prognostic biomarkers for prostate cancer (PCa).
• To identify tests for tissue, blood, and urine analyses suitable for selecting PCa patients for active surveillance (AS).
• To highlight potential new biomarkers for distinguishing low-risk PCa.

Main Methods:

• Literature review of PCa prognostic biomarkers.
• Selection of potential new biomarkers based on published research.
• Analysis of available tissue-based, blood-based, and urine-based tests for PCa risk classification.

Main Results:

• Four tissue-based, two blood-based, and six urine-based tests were identified for PCa risk classification.
• Most current tests are expensive, requiring cost-effectiveness analysis for healthcare system financing.
• Minimally invasive urine tests show promise for routine monitoring in AS patients.

Conclusions:

• Emerging biomarkers, including mRNA, miRNA, long noncoding RNA, and metabolites, show potential for improving AS patient selection.
• Further research and cost-effectiveness analyses are needed for the widespread adoption of new biomarkers.
• Advancements in urine-based tests offer a minimally invasive approach for managing PCa patients under AS.