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Biomarkers for screening and early detection of prostate cancer
Prostate cancer (PCa) represents a significant health burden and the high prevalence and natural course of the untreated disease make PCa ideal for screening and early detection. The aim of this review is to give an overview of the recent evidence on biomarkers for screening and early detection of PCa. A review of the current literature on prostate-specific antigen (PSA) and novel biomarkers in PCa diagnosis and screening was conducted using MEDLINE/PubMed to identify relevant publications. PSA is currently the main biomarker for PCa screening and diagnosis, and two out of three recent randomized controlled trials on PSA screening for PCa showed a 20–40% risk reduction of PCa-specific mortality in the screened group. In contrast, one study did not show any beneficial effect of PSA screening. Although each study had flaws, the study that reported no benefit from PSA screening had a high contamination rate in the control group and non-compliance in the screening group. However, PCa screening was associated with overdiagnosis, which led to overtreatment. Therefore, there is a need for novel biomarkers that are more specifically associated with PCa and its biological and clinical behaviour. Several such biomarkers are currently being investigated as an adjunct to PSA; however, none can currently replace PSA. Among novel biomarkers, PCa antigen 3 (PCA3) and TMPRSS2-ERG gene fusions appear to be most promising and, currently, PCA3 is reported as the more efficient diagnostic test in patients who have had a previous negative biopsy.