title: Prostate cancer biomarkers: Are we hitting the mark?
abstract: OBJECTIVE
  Localised prostate cancer diagnosis and management is increasingly complex due to its heterogeneous progression and prognostic subgroups. Pitfalls in current screening and diagnosis have prompted the search for accurate and invasive molecular and genetic biomarkers for prostate cancer. Such tools may be able to distinguish clinically significant cancers from less aggressive variants to assist with prostate cancer risk stratification and guide decisions and healthcare algorithms. We aimed to provide a comprehensive review of the current prostate cancer biomarkers available and in development.
  
  
  METHODS
  MEDLINE and EMBASE databases searches were conducted to identify articles pertaining to the use of novel biomarkers for prostate cancer.
  
  
  RESULTS
  A growing number of novel biomarkers are currently under investigation. Such markers include urinary biomarkers, serology-based markers or pathological tissue assessments of molecular and genetic markers. While limited clinical data is present for analysis, early results appear promising. Specifically, a combination of serum and urinary biomarkers (Serum PSA + Urinary PCA3 + Urinary TMPRSS2-ERG fusion) appears to provide superior sensitivity and specificity profiles compared to traditional diagnostic approaches (AUC 0.88).
  
  
  CONCLUSIONS
  The accurate diagnosis and risk stratification of prostate cancer is critical to ensure appropriate intervention. The development of non-invasive biomarkers can add to the information provided by current screening practices and allows for individualised risk stratification of patients. The use of these biomarkers appears to increase the sensitivity and specificity of diagnosis of prostate cancer. Further studies are necessary to define the appropriate use and time points of each biomarker and their effect on the management algorithm of prostate cancer.
authors.affiliation: Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia.
authors.forename: Shannon
authors.initials: S
authors.lastname: McGrath
authors.affiliation: Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Christidis
authors.affiliation: Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia.
authors.forename: Marlon
authors.initials: M
authors.lastname: Perera
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seoul, South Korea.
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.affiliation: Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia.
authors.forename: Todd
authors.initials: T
authors.lastname: Manning
authors.affiliation: Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Queensland University of Technology, Australian Prostate Cancer Research Center-Queensland, Brisbane, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Vela
authors.affiliation: Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Lawrentschuk
keywords: Biomarker; Diagnosis; Prostate cancer; Prostate specific antigen