**6. Conclusion**

10 Prostate Cancer – Diagnostic and Therapeutic Advances

Protein expression (tissue) Potential therapeutic target

One of the major secretory proteins of the prostate gland

uPAR expression in DTCs (bone marrow, peripheral blood), Potential therapeutic target

Potential Multiplex test with other

Potential Multiplex test with other

Potential Multiplex test with other

Potential Multiplex test with other

Potential therapeutic target

urine biomarkers

urine biomarkers

urine biomarkers

urine biomarkers,

tissue) Potential therapeutic targets

**Markers Strategy of Detection Comments** 

Protein expression (tissue)

Protein expression (tissue)

Protein expression (tissue)

Methylation specific PCR

amplification assay (urine)

Protein expression (tissue)

Despite bone marrow analysis provides important information, peripheral blood studies are more acceptable in the clinical management than invasive BM aspirations. However, identification of circulating tumor cells (DTCs) require extremely sensitive analytical methods that are usually combined with enrichment procedures. Although promising results from patients with advanced stages demonstrate the value of CTCs technology (currently evaluated and validated in clinical trials as a predictor and surrogate endpoint of

(blood, urine)

RT-PCR (urine) FISH (tissue)

PSCA RT-PCR (blood),

PSP94 ELISA (blood),

ECPA/ECPA-2 ELISA (blood),

uPA/uPAR ELISA (blood),

Loss of heterozygoty PCR (blood, urine)

PCA3 Transcription-mediated

AMACR RT-PCR (blood, urine)

MicroRNAs RT-PCR (blood, urine,

Metabolomics Profiling (urine, blood)

Disseminated Tumor Cells Enumeration (blood, bone

marrow)

Table 1. Potential biomarkers and their strategy of detection

Epigenetic markers

Gene fusion proteins (eg. TMPRSS2 :ERG)

(eg. GSTP1)

We have here attempted to give some examples of potential DNA-based, RNA-based and protein-based markers of aggressiveness in prostate cancer. Comparisons between studies are often difficult because of some inconsistencies between study cohorts, collection methods and handling of samples. It is unlikely that a single biomarker (evaluated on conventional approach looking at a single molecular predictor significantly up- or downregulated) will provide the information requested to tell how aggressive a diagnosed prostate cancer is. New research methods (proteomics, metabolomics…) are also emerging, and high-throughput technologies will facilitate biomarker discovery. Therefore, future advances in this field will probably have to integrate proteomics, transcriptomics and multiplex approaches and identify combinations of multiple biomarkers in order to improve the characterization of aggressive prostate cancers.
