Department of Urology, University of California at Davis, Davis, CA, USA
Abstract: Prostate cancer is the most commonly diagnosed non-cutaneous solid malignant tumor in the United States. Traditionally, Asian men have been considered low risk for prostate cancer. However, recent research suggests that the prevalence of prostate cancer is increasing in Asian men. This may represent an emerging public health problem with potentially serious consequences for patients and for health care systems. Given a predicted increase in the number of men diagnosed with prostate cancer in Asian countries, there is a clear and present need for optimized protocols for diagnosis and management of this condition in Asian men. Development of such protocols may benefit from novel technologies and lessons learned in Western countries; in this manner patients may receive optimal care and healthcare systems may mitigate the burden of over diagnosis (and subsequent overtreatment) which has complicated management of prostate cancer in the US and other Western nations. Genomic and other molecular testing offers a unique way to stratify oncological risk beyond simple serum, histological, and radiographic markers. These technologies measure genomic or molecular markers that provide novel insights into the biology of prostate tissue and prostate tumors. A variety of molecular biomarkers are in commercial use currently; these include tests designed to: (I) appropriately identify men for prostate biopsy, (II) select men likely to benefit from definitive treatment, and (III) determine which men who should consider adjuvant treatment after initial therapy. Integration of these molecular markers into the care of prostate cancer patients will require changes in how physicians make clinical decisions and counsel patients. These technologies must also be considered in light of improvements in imaging for prostate cancer. In the future, appropriate utilization of traditional, molecular, and radiographic tools will hopefully optimize care of the prostate cancer patients while simultaneously reducing costs to healthcare systems.