New targets for molecular diagnosis of prostate cancer: beyond the era of PSA

The incidence of prostate cancer has risen in most countries in the last decade. Unfortunately, standard diagnostic prostate cancer markers are not only lacking in cancer specificity but are also unable to differentiate between clinically insignificant and aggressive disease or to predict cancer progression. This frequently leads to unnecessary prostate biopsies and over-treatment of patients with indolent tumors. Therefore, there is an increased need to discover a more reliable molecular marker or a set of markers allowing for the early identification of patients with aggressive or clinically relevant prostate cancer and to determine the prognosis of the disease. The significant improvement in technology and understanding of genetics has led to the identification of serum and urine molecular DNA and RNA biomarkers including: GSTP1 and PCA3. Furthermore, a new prostate cancer specific genetic aberration has been identified, namely TMPRSS2: ERG gene fusion. In the most recently published study, the metabolomic profile of prostate cancer has been extensively explored. New molecular markers are showing an increased specificity in prostate cancer detection. However, a panel of multiple biomarkers appears necessary to precisely characterize this very heterogeneous disease. Genetic alterations and metabolic changes accompanying prostate cancer progression might have relevant therapeutic implications. This review aims at presenting some of the recently developed prostate cancer molecular biomarkers and considers their clinical performance.