Introduction: Recently, an increasing number of systemic therapies with life extending
capacity have become available in metastatic castration resistant prostate cancer (mCRPC) i.e.
Abiraterone acetate, Enzalutamide, Sipuleucel-T, Docetaxel, Cabazitaxel and Radium-223. More
compounds are currently being evaluated in promising pivotal trials (e.g. Tasquinimod, ARN-509,
ODM-201, and more). Limitations of the currently available biomarkers make treatment decisions
challenging. Considering the ever increasing complexity of treatment algorithms in mCRPC the
current demand of research is to find and characterize biomarkers with prognostic, predictive and
surrogate quality, allowing for information on clinically meaningful outcomes and on which therapy to offer patients in
different and complex scenarios.
Methods: A comprehensive English-language literature review was performed through PubMed to identify articles and
abstract presentations of the major conferences on cancer during December 2014.
Results: In this review we address established biomarkers like prostate specific antigen, lactate dehydrogenase and
alkaline phosphatase. Emerging biomarkers like circulating tumor cells, androgen receptor splice variants, cancer stem
cells and imaging biomarkers have also been reviewed and placed in the context of prognostic, predictive and surrogate
implications in the current field of CRPC. We elaborate on the requirements of good biomarkers and discuss possible
future developments of biomarkers in CRPC. Advances in knowledge of biomarkers in CRPC and thus biomarker driven
therapy monitoring and up-front therapy decisions may help in the future to tailor treatment algorithms, give information
on which therapy to offer and when to continue a given therapy in equivocal scenarios. This could maximize treatment
benefit and minimize toxicity.