Liquid Biopsy in Non-Metastatic Prostate Cancer: Clinical Evidence and Future Directions

Area of Science:

• Oncology
• Molecular Diagnostics
• Urology

Background:

• Liquid biopsy offers advanced prostate cancer management insights, but its role in non-metastatic disease is unclear.
• Conventional biomarkers like PSA have limitations in detecting minimal residual disease and biological aggressiveness.
• This review evaluates circulating tumor cells (CTCs) and ctDNA in non-metastatic prostate cancer.

Purpose of the Study:

• To critically assess the evidence for CTCs and ctDNA in non-metastatic prostate cancer.
• To determine the feasibility and prognostic value of liquid biopsy in this patient group.
• To explore potential clinical applications of liquid biopsy in non-metastatic prostate cancer management.

Main Methods:

• A narrative review of PubMed-indexed studies on liquid biopsy in localized or non-metastatic prostate cancer.
• Analysis of studies involving patients treated with curative intent or experiencing biochemical recurrence.
• Evaluation of CTC and ctDNA detection rates, prognostic associations, and survival outcomes using various liquid biopsy assays.

Main Results:

• CTC detection via EpCAM platforms was infrequent and had limited prognostic value in localized disease and recurrence.
• ctDNA was detectable in a subset of patients, consistently indicating biologically aggressive disease and higher recurrence risk.
• Ultra-sensitive, tumor-informed ctDNA assays showed particular promise in identifying aggressive disease.

Conclusions:

• Liquid biopsy, especially ctDNA, is a promising tool for detecting minimal residual disease and refining risk assessment in non-metastatic prostate cancer.
• ctDNA can serve as a biological risk modifier, potentially influencing adjuvant therapy decisions.
• Prospective biomarker-driven trials are essential to validate these findings before routine clinical implementation.