Noninvasive biomarkers to guide intervention: toward personalized patient management in prostate cancer

Prostate cancer (PCa) is one of the most frequently diagnosed malignancies worldwide and is associated with high mortality. Broad screening through prostate-specific antigen analysis, along with an aging and growing population has resulted in a vast increase in PCa incidence. As not all PCa forms are life threatening, personalized management is of paramount importance to preserve survival and quality of life for the diagnosed patients. Owing to the complexity of PCa, noninvasive biomarkers for diagnosis, stratification and monitoring, are essential to tailor intervention among patients with different disease manifestations. In this article, we aim to provide a critical assessment of the reported noninvasive biomarkers for PCa and their applicability according to the targeted clinical context. For this purpose, a systematic review of the literature published within the last five years was performed, focusing on noninvasive biomarkers to guide initial and repeated biopsies, stratify for active surveillance, monitor biochemical recurrence and metastasis, and adjust treatment for metastatic castration resistant PCa. Evidence from clinical trials on novel drugs and latest technological advancements, indicate several clinical applications for biomarkers to tailor intervention throughout PCa progression, toward a more personalized medicine approach in PCa clinical management.