Genetic classifiers for prostate cancer: A new era on the horizon?

Abstract

Since the introduction of the prostate-specific antigen (PSA) test, there has been a clear shift towards diagnosis at an earlier stage of prostate cancer. However, patients who receive curative treatment in the contemporary era still face significant risks of recurrence and disease progression. In most cases of tumor recurrence, salvage treatment is performed. As can be seen from general clinical experience, not all forms of salvage therapy guarantee control of disease status or cure. Although debate continues on the benefit of adjuvant therapy in comparison with salvage therapy, it cannot be denied that there may well be a proportion of patients who would benefit from earlier adjuvant intervention rather than salvage therapy given the identification of disease recurrence or progression. Thus, a definite need exists for more accurate predictors of the prognosis and outcome of prostate cancer. It is now clear that PSA and other PSA-related markers are not enough to do the job. Even though the Gleason score is widely regarded as a powerful predictor of outcome of prostate cancer, the possibility of intra- and interobserver variability exists. Certainly, the limitations in prognostications of prostate cancer patients are the primary reason for over- and undertreatment. To overcome such limitations, several genetic classifiers have recently been introduced. Two new molecular classifiers