Markers of prostate cancer: The role of circulating tumor markers in the management of bone metastases

Abstract

The present chapter concerns the role of circulating tumor markers in the management of bone metastases in patients with prostate cancer. We first discuss the contemporary notion of tumor markers from a general point of view. We focus on some specific characteristics of prostate-specific antigen (PSA), showing why it is the sole circulating tumor marker presently recommended in the follow-up of patients-with or without metastases-treated with curative intents for a primary prostate cancer. The role of PSA in the different clinical settings in which the marker may be used is then discussed. The position of the most recent clinical practice guidelines is examined, and recommendations concerning PSA are presented and discussed with reference to key clinical scenarios. We considered the initial assessment of the risk of developing bone metastases, the early detection of relapse during the follow-up, and the management of the relapse; this latter issue is discussed considering separately patients with biochemical relapse and those with manifest clinical metastases.