Bloodborne biomolecular markers in prostate cancer development and progression

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Abstract
Bloodborne markers for prostate cancer have been known for almost 70 years but many have lacked specificity. The development of the prostate-specific antigen (PSA) blood test as a surrogate marker for disease in the 1980s has revolutionized the diagnosis and management of prostate cancer. Levels of testosterone and other sex hormones provide useful information regarding the effectiveness of hormone therapy, but are not generally helpful for assessing prostate cancer risk or prognosis. Neuroendocrine cells are an integral part of the prostatic epithelium and the degree of neuroendocrine differentiation in prostate tumours seems to correlate with grade and aggressiveness of adenocarcinomas. Specific neuroendocrine markers are detectable in blood and their presence can influence therapeutic decisions. PSA is a secreted serine protease and other members of this class of extracellular protease seem to be important in normal and pathological prostate physiology. Tumour angiogenesis is important in prostate tumour progression and certain angiogenic growth factors, such as vascular endothelial growth factor, have shown prognostic significance in advanced disease. Levels of the growth factor insulin-like growth factor 1 correlate positively with the risk of developing prostate cancer and might prove useful in targeting prevention efforts in men at high risk of disease. Bone metabolites, particularly breakdown products of collagen, can reflect changes in bony lesions, which are a prominent component of metastatic prostate cancer. New proteomic technologies allow the simultaneous analysis of several bloodborne factors from small samples. These hold promise for more selective serological fingerprinting of prostate cancer patients for both diagnostic and prognostic purposes.