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Abstract

Volume 11, Issue 1 (January 2009) 11, 14–21; 10.1038/aja.2008.20

Molecular markers in prostate cancer. Part I: predicting lethality

Sachin Agrawal and William D. Dunsmuir

Department of Urology, St. Peters Hospital, Chertsey KT160PZ, UK

Correspondence: Mr Sachin Agrawal, Department of Urology, St. Peters Hospital, Chertsey KT16 0PZ, UK. Tel: +44-19-3272-2640 E-mail: agrawalsachin@hotmail.com

Received 29 September 2008; Accepted 2 October 2008; Published online 1 December 2008

Abstract

Assessing the lethality of 'early,' potentially organ-confined prostate cancer (PCa) is one of the central controversies in modern-day urological clinical practice. Such cases are often considered for radical 'curative' treatment, although active surveillance may be equally appropriate for many men. Moreover, the balance between judicious intervention and overtreatment can be difficult to judge. The patient's age, comorbidities, family history and philosophy of self-health care can be weighed against clinical features such as the palpability of disease, the number and percentage of biopsy cores involved with the disease, histological grade, presenting prostate-specific antigen (PSA) and possible previous PSA kinetics. For many years, scientists and physicians have sought additional molecular factors that may be predictive for disease stage, progression and lethality. Usually, claims for a 'new' unique marker fall short of true clinical value. More often than not, such molecular markers are useful only in multivariate models. This review summarizes relevant molecular markers and models reported up to and including 2008.

Keywords: genetics, neoplasm metastasis, prostate cancer

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