Prognostic and predictive biomarkers for castration resistant prostate cancer
Despite significant advances in diagnosis and management, prostate cancer is still a leading cause of cancer-related death in men. Castration-resistant prostate cancer (CRPC) is defined by disease progression despite androgen deprivation and castrate levels of testosterone. There have been a rapidly increasing number of new systematic agents which have been approved by the USFDA for men with metastatic CRPC, based on the results of successful phase 3 trials of a diverse range of agents with immunomodulatory, hormonal, bone-targeting, and microtubule-targeting mechanisms of action. Therefore, it is becoming essential to understand the optimal and rational combination and sequences of these treatments in the clinic, as well as to identify patients most likely to benefit from a specific treatment. Minimizing harms and costs of ineffective therapies is an equally important goal. Predictive biomarkers linked to relevant clinical outcomes are thus needed in drug development in CRPC, and there is an increasing need for these biomarkers to guide a clinician’s decision. We discuss in this chapter existing and emerging prognostic and predictive biomarkers in CRPC and future directions of biomarker development in men with CRPC.