Serum testosterone improves the accuracy of Prostate Health Index for the detection of prostate cancer

Comprehensive assessment for novel prostate cancer markers in the prostate-specific antigen era: focusing on Asians and Asian countries

We reviewed the current evidence for three novel prostate tumor markers (PCA3, TMPRSS2:ERG and proPSA) that have been recently reported predominantly in Western countries. We focus our attention on Asian men in both clinical and basic research studies. There have been no reports on the clinical usefulness of these three markers for Asians living in Western countries. In Asian countries, evidence for the clinical usefulness of PCA3 and proPSA-related indices including Prostate Health Index is being accumulated, mainly in Japan. The process for how a novel marker is approved in the clinical setting is also discussed.

Serum markers in prostate cancer detection

PURPOSE OF REVIEW

Prostate-specific antigen (PSA) testing provides significant benefits by reducing prostate cancer mortality, but also leads to important harms by detecting clinically insignificant cancers. Hence, there are urgent needs for complementary tools for middle-aged men with modest PSA elevations in blood. This review includes research on prostate cancer biomarkers in blood published from March 2013 through August 2014.

RECENT FINDINGS

Research progress has been made mainly on PSA as a predictive marker and in the field of kallikrein-based tests: [-2] proPSA, the prostate health index, and a panel of four kallikrein markers. As men with PSA levels below age-median are at very low 20-year risk of metastatic prostate cancer, individualized screening intervals, based on PSA levels, may help in reducing screening costs, prostate biopsies, and detection of insignificant cancer. Statistical models based on kallikrein-markers in blood improve the specificity at modestly elevated PSA (2-10 ng/ml), eliminate unnecessary biopsies, and help selecting men at risk of significant prostate cancer for biopsy or imaging.

SUMMARY

Individualized, risk-adapted PSA testing intervals and reflex-testing of kallikrein-markers for men with modestly increased PSA values may decrease the harms of screening. However, the clinical value of the proposed testing algorithms and additional tests awaits definitive confirmation in prospective trials.