Prostate cancer is the most common cancer and second leading cause of cancer deaths among
men in the United States. Most men have localized disease diagnosed following an elevated serum prostate
specific antigen test for cancer screening purposes. Standard treatment options consist of surgery or definitive
radiation therapy directed by clinical factors that are organized into risk stratification groups. Current clinical
risk stratification systems are still insufficient to differentiate lethal from indolent disease. Similarly, a subset of
men in poor risk groups need to be identified for more aggressive treatment and enrollment into clinical trials.
Furthermore, these clinical tools are very limited in revealing information about the biologic pathways driving
these different disease phenotypes and do not offer insights for novel treatments which are needed in men with
poor-risk disease. We believe molecular biomarkers may serve to bridge these inadequacies of traditional
clinical factors opening the door for personalized treatment approaches that would allow tailoring of treatment
options to maximize therapeutic outcome. We review the current state of prognostic and predictive tissuebased
molecular biomarkers which can be used to direct localized prostate cancer treatment decisions,
specifically those implicated with definitive and salvage radiation therapy.
Keywords: Biomarkers, prostate cancer, radiation therapy, RTOG, salvage radiation therapy, prostate specific antigen, biopsy, Tumor-Node-Metastasis, local therapy, surgery, focal therapy, brachytherapy, DNA damage, hormone deprivation therapy (ADT), apoptosis
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