Distinguishing Indolent from Aggressive Prostate Cancer

Abstract

Prostate cancer natural course is variable and it is difficult to determine prognosis on the basis of limited clinical information. In order to distinguish between aggressive and indolent tumors, genomic analysis, proteomic studies, and biomarker measurement were applied. Identification of single nucleotide polymorphisms may help to assess prostate cancer risk, however, it is questionable whether single nucleotide polymorphisms may predict a good or bad prognosis. Results of genomic and proteomic analyses between different laboratories may be difficult to compare because of non-standardized procedures which may be responsible for variant results. One of the early changes in prostate tumor tissues which may indicate a bad prognosis is high phosphorylation of Akt. A biomarker which is specific for prostate cancer is the TMPRSS2-ERG fusion which occurs in about 50% of tumors. Experimental studies indicate that this gene fusion may promote malignant phenotype. Biomarkers which could distinguish between latent and aggressive tumors may be detected in prostate tissue, serum, and urine. In summary, there is a limited progress in the field of prognostic biomarkers because of prostate cancer heterogeneity and missing unification of diagnostic procedures.