Diagnostic and Risk Stratification Molecular Markers of Prostate Cancer Beyond PSA

Prostate cancer still represents the most common urinary malignancies and the second most common cancer in adult men after skin cancer. Prostate specific antigen (PSA) represents a milestone in the diagnosis and screening of prostate cancer since its introduction even considering its limitations in term of sensitivity and specificity. The widespread use of PSA often led to unnecessary biopsies and to the diagnosis of indolent cancers that do not require treatment, therefore in the era of tailored personalized medicine there is a strong need for new markers that overcome PSA and that can help to identify the patients that have clinically significant disease that must be treated. To date different urinary and serum biomarkers have been proposed in the diagnostic setting with promising results in terms of sensitivity and specificity, however, none of them have been routinely introduced in clinical practice. In this review we reported the latest evidence for prostate cancer diagnosis in terms of urinary and blood biomarkers. Considering all the available markers, it is highly unlikely that one single assay could fit all the requirements and it seems appropriate to use the combination of different urinary and serum markers together with clinical parameters in order to guarantee a good diagnostic performance and to identify only clinically significant disease