Biomarker in Active Surveillance for Prostate Cancer: A Systematic Review

SIMPLE SUMMARY: Recently, biomarkers have become a supplemental tool to aid in the diagnosis and evaluation of prostate cancer. Numerous biomarkers are being developed, but no one has a place in current clinical practice for active surveillance. However, active surveillance is a curative treatment option that shifts the possible timing of treatment, but misclassification and progression impose regular monitoring of patients that could be improve by biomarkers. The aim of this review is to investigate the potential of biomarker performance for active surveillance selection and outcome prediction. Our study has identified the critical role that biomarkers could play in piecing together an individualised prognostic for each patient and their use in active surveillance. Although no single biomarker should determine therapy, each biomarker should be considered as a piece of the puzzle in the important decision-making process. ABSTRACT: Active surveillance (AS) in prostate cancer (PCa) represents a curative alternative for men with localised low-risk PCa. Continuous improvement of AS patient’s selection and surveillance modalities aims at reducing misclassification, simplifying modalities of surveillance and decreasing need for invasive procedures such repeated biopsies. Biomarkers represent interesting tools to evaluate PCa diagnosis and prognosis, of which many are readily available or under evaluation. The aim of this review is to investigate the biomarker performance for AS selection and patient outcome prediction. Blood, urinary and tissue biomarkers were studied and a brief description of use was proposed along with a summary of major findings. Biomarkers represent promising tools which could be part of a more tailored risk AS strategy aiming to offer personalized medicine and to individualize the treatment and monitoring of each patient. The usefulness of biomarkers has mainly been suggested for AS selection, whereas few studies have investigated their role during the monitoring phase. Randomized prospective studies dealing with imaging are needed as well as larger prospective studies with long-term follow-up and strong oncologic endpoints.