Epigenetic changes in prostatic tissues: Evidence of field cancerization

Prostate cancer (PC) alone accounts for 25% of incident cases of cancer in men and is the most frequently diagnosed cancer in American men. Early diagnosis is essential for successful management of PC. Current diagnostic methods have significant drawbacks leading to a significant dilemma in selecting the appropriate management strategy. The need for improving both the diagnostic accuracy and prognostic prediction is evident. There is overwhelming evidence to support the view that epigenetic markers in PC can have diagnostic, therapeutic and prognostic implications. Two of the well-studied epigenetic mechanisms are aberrant DNA methylation and histone modifications. The identification of specific genetic alterations can help in both establishing a diagnosis and also provide useful prognostic information. It is also exciting to know that epigenetic changes are heritable and potentially reversible. Hence, it is reasonable to expect that these can be used as potential therapeutic targets. Currently there are several drugs that are at different stages of development. More recent evidence has focused on a field cancer effect in PC. Epigenetic changes as evidence to this field cancerization have important clinical implications in chemoprevention, early diagnosis, prognostic prediction and active surveillance.