Samir S. Taneja, MD, Consulting Editor

Historically, the surgical treatment of urologic malignancies was limited by late detection. By the time tumors became symptomatic, it was too late for us to help the patient. In the case of prostate cancer, for which serum PSA has allowed early detection, and to a lesser extent kidney cancer, for which incidental detection on imaging has allowed earlier detection, survival following surgery has improved and the challenge of treatment has changed. We now must figure out if every tumor we find truly warrants therapy, and this question may be best answered through the use of alternate biomarkers capable of distinguishing indolent from aggressive disease. In the cases of bladder and testis, earlier detection has been achieved to some extent through patient education, but true screening tests do not exist. In these diseases, improvements in outcome have come solely through improvements in therapy. The application of aggressive therapy has resulted in improved outcomes for those destined to die of disease, but potentially leaves some overtreated (much as in the case of prostate cancer). As such, the role of biomarkers in these diseases may perhaps allow individualized treatment rather than avoidance of treatment. Biomarkers may allow us, in this case, to direct a treatment approach.

The use of biomarkers in clinical practice can range from screening, to refined detection in an at-risk population, to risk stratification following diagnosis, to prognostication following therapy. As such, an increasing knowledge of tumor biology and genetic heterogeneity will likely lead clinicians to adopt clinical paradigms that utilize sequences of biomarker assessments. It is critically important for urologists to remain at the forefront of the care of urologic malignancies, and knowledge of emerging biomarkers is an important component of this effort.

This issue, conceived and constructed by Dr Kevin R. Loughlin, provides a remarkably comprehensive overview of biomarkers in urologic oncology—not just for prostate cancer, but for all the cancers we treat. While the role of biomarkers may be more evident in some cancers than others (for now), their potential is truly pervasive. The authors have provided fantastic insight into individual biomarkers and the relationship of biomarkers to individual disease processes. I know the readers will be fascinated. We are deeply indebted to Dr Loughlin and all of the contributing authors for another truly outstanding issue of Urologic Clinics .