An Up-to-Date Catalogue of Urinary Markers for the Management of Prostate Cancer

Stephan Brönimann; Benjamin Pradere; Pierre Karakiewicz; Nicolai A. Huebner; Alberto Briganti; Shahrokh F. Shariat

Disclosures

Curr Opin Urol. 2020;30(5):684-688. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Prostate cancer (PCa) is the most commonly diagnosed cancer in men. Poor specificity and sensitivity of total PSA often results in over and sometimes underdetection/treatment. Therefore, more specific and sensitive biomarkers for the detection and monitoring especially of clinically significant PCa as well as treatment-specific markers are much sought after. In this field, urine has emerged as a promising noninvasive source of biomarkers.

Recent findings: RNA-based biomarkers are the most extensively studied type of urinary nucleic acids. ERG-Score/MiPS (Mi-Prostate Score) and SelectMDx might be considered as additional parameters together with clinical and imaging modalities to decrease unnecessary biopsies. miR Sentinel Tests could make it possible to accurately detect the presence of cancer and to distinguish low-grade from high-grade disease. In men with previous negative biopsies, PCA3 may suggest the need to repeat biopsy.

Summary: The definitive role of these markers and their clinical benefit needs future validation.

Introduction

Accounting for approximately 15% of all diagnosed cancers, prostate cancer (PCa) is the most commonly diagnosed cancer in men and the sixth leading cause of cancer death in men.[1,2]

Currently, early detection and screening strategies are based on the initial total PSA level and patient's life expectancy.[3,4] However, especially within the 4.0–10.0 ng/ml range, the lack of sensitivity and specificity of PSA for PCa may lead to overdiagnosis/treatment of clinically insignificant PCa resulting in harm to the individual and society in general (e.g. increased healthcare costs).[5] On the contrary, about 15% of patients with a normal PSA value harbour clinically significant prostate cancer (csPCa), leading to a delay in diagnosis and treatment.[6–8] Therefore, more accurate biomarkers for detection and management of PCa across the all disease stages are highly needed.[9–11]

Urine has emerged as a promising noninvasive source of biomarkers. Compared with blood, urine contains material that directly originates from the prostate gland. However, the composition of urine is highly variable due to a multitude of factors such as age, diet and physical activity, leading to inter as well as intraindividual differences. Apart from standard cytology analysis from the prostate, bladder and kidney, cellular content is also found such as DNA, RNA, proteins or exosomes.[12,13]

Numerous urinary markers have been recently assessed in scientific studies with initial results being very promising for PCa diagnosis and management. We reviewed the current literature in order to discuss recent findings and to create an up-to-date catalogue of urinary biomarkers in PCa.

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