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Molecular prognostic tests for prostate cancer

Ashley Ross, MD, PhD
Anthony V D'Amico, MD, PhD
Stephen Freedland, MD
Section Editors
Nicholas Vogelzang, MD
Jerome P Richie, MD, FACS
W Robert Lee, MD, MS, MEd
Deputy Editor
Michael E Ross, MD


Prostate cancer represents the most common visceral malignancy in men. While prostate cancer remains a lethal disease (killing roughly 1 in every 36 American males), it represents a disease spectrum, particularly when localized disease is diagnosed, with up to half of men not needing immediate intervention. In addition to this, there are men with higher risk localized disease for whom the extent of treatment remains unclear (ie, surgical only, radiation only, or a combined modality approach that may include surgery, radiation, and/or androgen deprivation). (See "Initial approach to low- and very low-risk clinically localized prostate cancer" and "Initial management of regionally localized intermediate-, high-, and very high-risk prostate cancer".)

In order to better stratify and predict risk of prostate cancer progression, multiple clinicopathologic parameters have been investigated, and nomograms have been developed. While these are powerful tools, they have limitations. Advances over the last decade have dramatically increased both our understanding of prostate cancer biology and our ability to obtain molecular information from small amounts of prostate tissue. Along with these advances have come newly available and emerging clinical molecular tests, which promise to help determine prostate cancer prognosis and guide treatment decisions. (See "Prostate cancer: Risk stratification and choice of initial treatment".)

Current molecular tests that may better determine the aggressiveness of prostate cancer have been developed either based on general features of malignancy (namely proliferation indices) or based on molecular features that are more specific for prostate cancer (table 1). These tests include those that are based on immunohistochemistry (IHC) and those based on ribonucleic acid (RNA) expression. These tests, their possible clinical applications, and the literature supporting their use are discussed here.


Tests based on cell proliferation include the evaluation by immunohistochemistry (IHC) of Ki-67, a nuclear protein that is associated with ribosomal ribonucleic acid (RNA) synthesis, and the cell cycle progression (CCP) score assessed by quantitative reverse transcription polymerase chain reaction (RT-PCR), which incorporates information from 31 cell cycle-related genes and 15 housekeeping genes.

Both Ki-67 IHC and the CCP score act as proxies for tumor proliferation. These tests have been employed in multiple retrospective cohorts, both with and without local treatment. Although they measure similar biological processes, they have not been directly compared; however, data for both tests appear similar.


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Literature review current through: Feb 2017. | This topic last updated: Oct 21, 2016.
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