The need for a personalized approach for prostate cancer management

Abstract

The stratification of patients for treatment of prostate cancer is based on very general parameters like prostate-specific antigen, Gleason score, and TNM classification. We use these rough parameters for selection of active surveillance, active treatment, and even for the treatment selection in metastasized or castration-resistant prostate cancers. Up to now, we have not used individualized genetic classifiers for detailed sub-stratification, thus treating all patients as equal, and being only moderately successful. With the expected increase in systemic treatments, there is an apparent need for such classifiers. We will address these needs in this short commentary.

Figure 1

Schematic presentation of the classic steps in the early diagnosis of prostate cancer and the same approach implementing recent US Food and Drug Administration-approved tests or those offered by CLIA laboratories. CCCP, cell cycle control panel; GPS, Genomic Prostate Score; MRI, magnetic resonance imaging; PCA3, prostate cancer gene 3; PHI, Prostate Health Index; PSA, prostate-specific antigen.