Optimization of PSA and its variants and other biomarkers for the follow-up of low-risk prostate cancer in active surveillance.

Introduction And Objectives: Active surveillance (AS) is currently a therapeuticstrategy recommended by all Clinical Guidelines forthe initial management of very low-risk, low-risk, andsome intermediate-risk prostate cancer (PCa). However,a high percentage of cases will present the need for active treatment and a quarter of them will presentunfavorable anatomopathological characteristics.

Methods: review of the biomarkers' literature oncircumscribed to the inclusion and follow-up of patientsin AS.

Results: PSA and its variants remain the most widelyused and most cost-effective biomarker in AS. Inparticular, the use of PSA density based on the prostatevolume detected by mpMRI has gained much weight.Different multipanel biomarkers in blood and urineare commercially available to predict progressionto PCa ≥3 + 4 (GG2), but they have not clearly beenprospectively tested in AS cohorts. Tissue biomarkersanalyze gene panels that offer predictive informationindependent of classical clinicopathological variablesand may play a role in controversial indications for AS.Lastly, risk calculators are cost-effective and validatedfor their care use in AS and are probably underused.

Conclusions: Although there is no specific biomarkerfor the optimization of AS, its rational use togetherwith mpMRI may in the future optimize the inclusionof patients in AS and follow-up differentiatedby risk groups.