Prostate-specific antigen (PSA) has been the primary biomarker used for the detection and monitoring of prostate cancer for decades. However, its limited specificity and prognostic accuracy have led to the development of novel molecular and imaging biomarkers aimed at improving the clinical characterization of localized disease. This review critically examines recent advances in urinary biomarkers (e.g., PCA3, SelectMDx), tissue-based genomic assays (Oncotype DX Prostate, Prolaris, Decipher), and imaging techniques such as multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography (PET-PSMA). We evaluate their diagnostic performance, prognostic value, and clinical utility in risk stratification and individualized treatment decision-making. Methodological and clinical barriers to their routine implementation are also discussed. Current evidence supports the multidisciplinary integration of these biomarkers to overcome the limitations of PSA, improve biopsy decision-making, better distinguish indolent from aggressive tumors, and optimize therapeutic strategies. Finally, future research directions aimed at validating and incorporating emerging biomarkers into clinical practice are outlined, with the goal of improving outcomes in patients with localized prostate cancer.

Prostate-specific antigen (PSA) has been the main biomarker used for the detection and monitoring of prostate cancer for decades. However, its limited specificity and prognostic accuracy have prompted the development of novel molecular and imaging biomarkers to improve the clinical characterization of localized disease. This review critically examines recent advances in urinary biomarkers (e.g., PCA3, SelectMDx), tissue-based genomic assays (Oncotype DX Prostate, Prolaris, Decipher), and imaging techniques such as multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography (PET-PSMA). We evaluate their diagnostic performance, prognostic relevance, and clinical utility in risk stratification and individualized treatment decision-making. Methodological and clinical barriers to their routine implementation are also discussed. Current evidence supports a multidisciplinary integration of these biomarkers to address the limitations of PSA, improve biopsy decision-making, better distinguish indolent from aggressive tumors, and optimize therapeutic strategies. Finally, future research directions aimed at validating and incorporating emerging biomarkers into clinical practice are outlined, with the goal of improving outcomes in patients with localized prostate cancer.

Liquid biopsy is an innovative approach that provides a more complete understanding of treatment response and prognosis in monitoring metastatic prostate cancer. It complements invasive tissue biopsy and involves the assessment of various biomarkers in body fluids such as blood, semen, and urine. Liquid biopsy analyzes circulating tumor cells, extracellular vesicles, circulating tumor DNA, and the secretome. This is particularly important given the heterogeneity of prostate cancer and the need for better prognostic biomarkers. Liquid biopsy can personalize the treatment of homonosensitive and castration-resistant metastatic prostate cancer by acting as a predictive and prognostic tool. This review discusses various biomarkers, assay techniques, and potential applications in daily clinical practice, highlighting the exciting possibilities that this emerging field holds for improving patient outcomes.

Background: This study evaluated the clinical outcomes of stereotactic ablative radiotherapy (SABR) in the treatment of oligometastatic pelvic node prostate cancer to delay androgen deprivation therapy (ADT). Materials and methods: Pelvic lymph node metastases were identified by ¹¹C-choline positron emission tomography (PET)-computed tomography (CT), and patients were not receiving ADT. SABR was administered using linear accelerators with intensity-modulated and image-guided radiotherapy, at a prescribed dose of 35 Gy in 5 fractions over 2 weeks. Response was assessed using Response Evaluation Criteria in Solid Tumours (RECIST) v1.1 criteria, and prostate-specific antigen (PSA) levels were monitored post-SABR. Toxicity and quality of life were assessed by the Common Terminology Criteria for Adverse Events Toxicity (CTCAE) v.5.0 and European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaires QLQ-C30/QLQ-PR25, respectively. Kaplan-Meier and T-test were used for statistical analysis. Results: Between June 2015 and November 2023, 56 patients with 85 lesions were treated at our institution. Median follow-up was 30 months [95% confidence interval (CI): 24–33.6]. Prostatectomy was the radical treatment in 85.7% of patients, and radiotherapy in 14.3%. Response rates were 67.1% for complete response, 27.4% for partial response, and 1.4% for stable disease. In-field progression was observed in only 3 lesions (3.5%). The median time to biochemical relapse post-SABR was 15 months (95% CI: 11.4–18.6). Three-year pelvic nodal and distant progression-free survival were 62.5% and 80%, respectively. There was a significant decrease in PSA levels after SABR compared to pretreatment levels (0.77 vs. 2.16 ng/mL respectively, p = 0.001). No grade ≥ 2 genitourinary or gastrointestinal toxicities. The median global health status score was 83.33 points at both time points analysed. Conclusion: SABR can delay the ADT and provide excellent local control while preserving quality of life. Keywords: stereotactic ablative radiotherapy oligorecurrence prostate cancer oligometastases pelvic lymph nodes