[Personalized medicine and prostate cancer. The reality of change]. / Medicina personalizada y cáncer de próstata. La realidad de un cambio.

Prostate cancer (PCa) is a public health problem in western male populations on the basis of it's high incidence and prevalence. Nowadays we come to changes in the diagnostic technologies that deserve special attention and that once applied allow to show the way towards a personalized view of PCa being able to join this modern current trend of the oncologic pathology. In spite of the recognized heterogeneity of the disease; clinical, pathological and genetic variants in genes and the limitations of the PSA as a biomarker to determine the biological aggressiveness of PCa, the certain thing is that the therapeutic final decision is adopted on the basis of a distant information to the wished customization and it moves excessive uncertainty for patients.In this respect the search based on the identification of alterations on the genomic sequence and it's influence in the molecular characterization of the PCa is a constant in the investigation since nowadays. Actually, the progressive adjournment to the clinic of information tumour information that comes from the diagnostic tests related genetic material or their biochemical products, though still in initial phase, already allows to predict relevant changes in molecular characterization of the prostate cancer, in the eventual availability of predictive biomarkers from susceptibility to suffer the disease and of the personalized stratification of risk across the incorporation of newly and interesting molecular and immunohistochemistry biomarkers. Likewise the advances in the perspectives opened with the diagnosis, and the relevance in the decisions of biopsy indications that stem from it are based on the utilization, with the corresponding merger of images, of the multiparametric magnetic resonance (mpMRI) and the new prostate ecographic transrectal images with it's natural evolution towards focal treatments represent, in spite of the recognized complex interpretation of the images, another significant transformation towards the individualization and ideally customization of the clinical decisions opposite to a certain patient with PCa. Events all of them, even more, if they are considered to be combined turn out to be very promising and it's integration brings us over to personalized medicine in PCa since already it happens in others, though still small, neoplastic diseases. All this aspects are summarized and discussed in the present article in the light of the recent communicated information and the reflection and personal experience of the authors. Finally chasing how to improve the clinical managing and the treatment for patients with PCa.

Medicina personalizada y cáncer de próstata. La realidad de un cambio / Personalized medicine and prostate cancer. The reality of change

El cáncer de próstata (CaP) es un problema de salud pública en la población masculina y en particular en los países occidentales en base a su elevada incidencia y prevalencia. Actualmente acudimos a cambios en las técnicas diagnósticas que merecen especial atención y que una vez aplicadas permiten vislumbrar el camino hacia la medicina personalizada en CaP pudiendo integrarse en esta moderna tendencia actual de la patología oncológica. A pesar de la reconocida heterogeneidad de la enfermedad; clínica, patológica y de su expresión génica, así como de las limitaciones del PSA como biomarcador para determinar la agresividad biológica de la enfermedad tumoral, lo cierto es que la decisión terapéutica final se adopta en base a una información lejana a la deseada personalización y, además, traslada excesiva incertidumbre a los pacientes. En este sentido, la búsqueda de otras alternativas entre las que destacan las basadas en la identificación de alteraciones en la secuenciación genómica y su influencia en la caracterización molecular del cáncer de próstata es una constante en la investigación. Actualmente, la progresiva traslación a la clínica de información tumoral en CaP que del material genético o el de sus productos bioquímicos, aunque todavía en fase inicial, ya permite predecir cambios relevantes en la caracterización molecular del CaP, en la eventual disponibilidad de biomarcadores predictivos de susceptibilidad para padecer la enfermedad y en la estratificación personalizada del riesgo a través de la incorporación de nuevos e interesante biomarcadores moleculares e inmunohistoquimicos. Asimismo, de forma paralela, los avances en las perspectivas abiertas con el diagnostico, y la trascendencia en las decisiones de indicación biopsica que de ella se derivan, basado en la utilización con la correspondiente fusión de imágenes, de la resonancia magnética multiparametrica (mpMRI) y las nuevas imágenes ecográficas prostáticas transrectales con su evolución natural hacia tratamientos focales representan, a pesar de la reconocida compleja interpretación de las imágenes otra significativa transformación hacia la individualización e idealmente personalización de las decisiones clínicas frente a un determinado paciente con CaP. Acontecimientos todos ellos, más aún, si se consideran combinados que resultan muy prometedores y cuya integración nos acerca cada vez más a la realidad de una medicina personalizada en CaP cáncer de próstata como ya ocurre en otras, aunque todavía pocas, patologías neoplásicas. Todos los aspectos comentados se resumen y discuten en el presente artículo a la luz de los recientes datos comunicados a la literatura y de la reflexión y experiencia personal de los autores. En definitiva, persiguiendo como mejorar el manejo clínico y el tratamiento de los pacientes con CaP

Prostate cancer (PCa) is a public health problem in western male populations on the basis of it´s high incidence and prevalence. Nowadays we come to changes in the diagnostic technologies that deserve special attention and that once applied allow to show the way towards a personalized view of PCa being able to join this modern current trend of the oncologic pathology. In spite of the recognized heterogeneity of the disease; clinical, pathological and genetic variants in genes and the limitations of the PSA as a biomarker to determine the biological aggressiveness of PCa, the certain thing is that the therapeutic final decision is adopted on the basis of a distant information to the wished customization and it moves excessive uncertainty for patients. In this respect the search based on the identification of alterations on the genomic sequence and it´s influence in the molecular characterization of the PCa is a constant in the investigation since nowadays. Actually, the progressive adjournment to the clinic of information tumour information that comes from the diagnostic tests related genetic material or their biochemical products, though still in initial phase, already allows to predict relevant changes in molecular characterization of the prostate cancer, in the eventual availability of predictive biomarkers from susceptibility to suffer the disease and of the personalized stratification of risk across the incorporation of newly and interesting molecular and immunohistochemistry biomarkers. Likewise the advances in the perspectives opened with the diagnosis, and the relevance in the decisions of biopsy indications that stem from it are based on the utilization, with the corresponding merger of images, of the multiparametric magnetic resonance (mpMRI) and the new prostate ecographic transrectal images with it´s natural evolution towards focal treatments represent, in spite of the recognized complex interpretation of the images, another significant transformation towards the individualization and ideally customization of the clinical decisions opposite to a certain patient with PCa. Events all of them, even more, if they are considered to be combined turn out to be very promising and it´s integration brings us over to personalized medicine in PCa since already it happens in others, though still small, neoplastic diseases. All this aspects are summarized and discussed in the present article in the light of the recent communicated in formation and the reflection and personal experience of the authors. Finally chasing how to improve the clinical managing and the treatment for patients with PCa