Markers in Prostate Cancer

Serum prostate-specific antigen (PSA) remains the most widely used diagnostic and prognostic marker for prostate cancer (PCa) despite its limitations of low sensitivity and specificity. Several modifications to PSA biomarker detection have been suggested to improve sensitivity and selectivity including PSA density, free:total PSA, PSA velocity (PSAV)?doubling time (PSADT) and different PSA isoforms. This chapter reviews the use of PSA, PSA subfractions, and other currently available markers approved by the US Food and Drug Administration (FDA) for use in the management of patients with PCa. The broad spectrum of numerous other markers for PCa that have been described (in serum, whole blood, molecular urine markers [RNA, DNA and protein], and cellular?genetic tests) are discussed. The evidence for some of the more promising biomarkers (including circulating tumor cells [CTC] in blood) currently under evaluation for detecting and predicting PCa outcome is also addressed.