{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:09:03Z","timestamp":1789042143134,"version":"build-2803163510"},"reference-count":140,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Prostate-specific antigen (PSA) has been the primary biomarker used for the detection and monitoring of prostate cancer for decades. However, its limited specificity and prognostic accuracy have led to the development of novel molecular and imaging biomarkers aimed at improving the clinical characterization of localized disease. This review critically examines recent advances in urinary biomarkers (e.g., PCA3, SelectMDx), tissue-based genomic assays (Oncotype DX Prostate, Prolaris, Decipher), and imaging techniques such as multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography (PET-PSMA). We evaluate their diagnostic performance, prognostic value, and clinical utility in risk stratification and individualized treatment decision-making. Methodological and clinical barriers to their routine implementation are also discussed. Current evidence supports the multidisciplinary integration of these biomarkers to overcome the limitations of PSA, improve biopsy decision-making, better distinguish indolent from aggressive tumors, and optimize therapeutic strategies. Finally, future research directions aimed at validating and incorporating emerging biomarkers into clinical practice are outlined, with the goal of improving outcomes in patients with localized prostate cancer.<\/jats:p>","DOI":"10.3390\/ijms26167667","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T09:56:42Z","timestamp":1754647002000},"page":"7667","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Biomarkers in Localized Prostate Cancer: From Diagnosis to Treatment"],"prefix":"10.3390","volume":"26","author":[{"given":"Marta","family":"Lopez-Valcarcel","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Puerta de Hierro University Hospital, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4077-0507","authenticated-orcid":false,"given":"Fernando","family":"Lopez-Campos","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Ramon y Cajal University Hospital, 28034 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4778-4271","authenticated-orcid":false,"given":"Juan","family":"Zafra-Mart\u00edn","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8965-3056","authenticated-orcid":false,"given":"Irene","family":"Cienfuegos Belmonte","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Virgen del Puerto Plasencia, C\u00e1ceres, 10600 Plasencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4176-8174","authenticated-orcid":false,"given":"Jos\u00e9 Daniel","family":"Subiela","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Universitario Ram\u00f3n y Cajal, IRYCIS, Universidad de Alcala, 28034 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5638-0634","authenticated-orcid":false,"given":"Mar\u00eda","family":"Ruiz-Vico","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9980-8572","authenticated-orcid":false,"given":"Sandra","family":"Fernandez Alonso","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Angel","family":"Garcia Cuesta","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, GenesisCare Spain, San Francisco de Asis University Hospital, 28002 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7233-0234","authenticated-orcid":false,"given":"Felipe","family":"Cou\u00f1ago","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, GenesisCare Spain, Hospital Universitario Vithas La Milagrosa, 28003 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15330338241290029","DOI":"10.1177\/15330338241290029","article-title":"Advancements in Biomarkers of Prostate Cancer: A Review","volume":"23","author":"Gbadebo","year":"2024","journal-title":"Technol. 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