LAUSR

The accurate identification and stratified treatment of clinically significant early-stage prostate cancer have been ongoing concerns since the outcomes of large international prostate cancer screening trials were reported. The controversy surrounding clinical and cost benefits of prostate cancer screening has highlighted the lack of strategies for discriminating high-risk disease (that requires early treatment) from low-risk disease (that could be managed using watchful waiting or active surveillance). Advances in molecular subtyping and multiomics nanotechnology-based prostate cancer risk delineation can enable refinement of prostate cancer molecular taxonomy into clinically meaningful and treatable subtypes. Furthermore, the presence of intertumoural and intratumoural heterogeneity in prostate cancer warrants the development of novel nanodiagnostic technologies to identify clinically significant prostate cancer in a rapid, cost-effective and accurate manner. Circulating and urinary next-generation prostate cancer biomarkers for disease molecular subtyping and the newest complementary nanodiagnostic platforms for enhanced biomarker detection are promising tools for precision prostate cancer management. However, challenges in merging both aspects and clinical translation still need to be overcome.In this Review, the authors discuss biomarker-driven prostate cancer molecular subtyping and the development of nanodiagnostic strategies to refine biomarker detection. They also describe the challenges of merging both aspects for precision prostate cancer management.Key pointsThe accurate identification and personalized treatment of high-grade, clinically significant prostate cancer have been ongoing concerns since the outcomes of large international prostate cancer screening trials were published.The combination of next-generation prostate cancer biomarker discoveries and the emergence of companion nanodiagnostic technologies could lead to a new era of precision prostate cancer management.In-depth profiling of prostate cancer has resulted in the discovery of next-generation biomarkers such as TMPRSS2–ETS fusion genes, PCA3 and SCHLAP1, which could improve molecular subtyping and risk stratification.Evolving nanotechnologies such as novel nanomaterials and nanoparticles might benefit clinical translation of next-generation prostate cancer biomarkers by improving detection speed and sensitivity for development of point-of-care diagnostics.Challenges for translating both novel biomarkers and nanotechnology platforms into the clinic still need to be overcome by bridging the gap between clinical and diagnostic disciplines.