Personalization of prostate cancer prevention and therapy: are clinically qualified biomarkers in the horizon?

Prostate cancer is the leading malignancy among males and the second most common cause of male cancer-related deaths after lung cancer [1]. Although the disease is potentially curable with local therapy when confined to the prostate gland, approximately 33% of patients develop resistance to local treatments and eventually progress to have incurable metastatic disease. Mortality from this disease is usually due to resistance to androgen deprivation therapy and the eventual development of castration resistant prostate cancer (CPRC). The molecular etiology of the development of resistance to prostate cancer therapies is still not fully understood, with previous and ongoing studies hindered by inadequate preclinical models and issues in acquiring prostate tumor tissue [2].Strategies developed to counteract androgen-deprivation therapy resistance have had only modest clinical benefit. Indeed, prior to 2010, only docetaxel chemotherapy improved overall survival in patients with CRPC compared with mitoxantrone [3]. However, with recent developments in novel chemotherapeutics and targeted agents, there appears to be a new dawn in the management of prostate cancer, with a number of novel anticancer drugs for CRPC recently entering the clinic. The key antitumor agents that have shown greatest promise include the novel taxane cabazitaxel (Jevtana, Sanofi-Aventis) [4], the vaccine sipuleucel-T (Provenge; Dendreon) [5], the CYP17 inhibitor abiraterone (Zytiga; Ortho Biotech) [6], the novel androgen-receptor antagonist MDV-3100 (Medivation/Astellas) [7] and the radioisotope alpharadin (radium 223; Algeta/Bayer Pharma AG) (Table 1) [3].It is therefore now critical that these novel agents are appropriately applied to the CRPC treatment pathway to maximize benefit for patients suffering from advanced-stage prostate cancer, while minimizing toxicities and cost. Thus, the discovery of biomarkers and diagnostics for prostate cancer screening, as well as the development of predictive an