In the last 25 years, Prostate Specific Antigen (PSA) screening has resulted in a large gap between the likelihood of being diagnosed with and of dying of prostate cancer, leading to the clinical problems of overdiagnosis and overtreatment. Despite the favorable outcomes reported for active surveillance, its clinical use is limited, with >90% of men in the US diagnosed with potentially indolent disease undergoing immediate treatment with radiation or surgery. We have designed a novel strategy of molecular profiling of prostate cancers, allowing an assessment of tumor aggressiveness to be based on tumor tissue obtained at biopsy. The results have led to a soon-to-be clinically available test that will allow improved selection of men for active surveillance.

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