Prostate Cancer Tissue-Based Biomarkers

Excerpt

Prostate cancer is the malignancy arising from the prostate gland in men. Cancer of the prostate is the fourth most common malignancy worldwide amongst both sexes and is the fifth leading cause of death in men, according to the 2020 census. It is also a malignancy related to a nation’s development index, like breast, lung, and colorectum cancers.

The cumulative incidence and mortality risk are higher in countries with very high Human Development Index (HDI) scores (7.88%) as opposed to those nations with low HDI (3.29%) scores.

In general, the incidence and mortality of prostate cancer are lowest in Asia and highest in the Caribbean and Africa. Western Europe, Australia, and North America have relatively high incidence rates but low mortality.

Even though patients with prostate cancer have improved overall survival, from a global perspective, this is a disease that requires attention in terms of better diagnostic and treatment modalities, especially in the metastatic setting. Properly used prostate cancer tissue-based biomarkers can significantly improve prognostic determinations, risk stratification, and treatment selection.

Until recently, prostate cancer diagnosis and risk stratification has been based solely on clinical stage, grade group/Gleason score, and prostate-specific antigen (PSA) levels. The tumor being highly heterogenous, Gleason scoring adopts a sum of scores from two different histological areas. Clinicians use these variables to construct nomograms and risk calculators. The most commonly used prognostic tools are the Partin tables (to predict tumor and nodal stage after radical prostatectomy), the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram (predicts postoperative progression-free survival in addition to the tumor and nodal stage after radical prostatectomy), and the Cancer of the Prostate Risk Assessment (CAPRA) score (to predict postoperative high-risk features, lymph node involvement and recurrence-free survival at 3 and 5 years). Additional tools are the Briganti nomogram and the Kattan nomogram.

Taken together, these clinicopathological variables and prognostic tools, though somewhat useful in real-world clinical situations, are inadequate to reliably predict the course of the disease as evidenced by real-world experience. Worse, they are rapidly becoming obsolete as the field of oncology is being catapulted by cutting-edge molecular diagnostics revolving around cancer genomics, transcriptomics, biomarkers, and epigenomics.

This article addresses the utility and clinical application of new and cutting-edge prostate cancer tissue-based biomarker assays that have either been approved by regulatory bodies or are in a developmental pipeline awaiting further research.