Background: Although a rapidly growing number of candidate biological markers of prognosis and/or response to specific treatments in prostate cancer, none have to date showed ability to completely prognosticate prostate cancer on evidence based urology. Objective: To review the pertinent literature on the issue. Acquisition of evidence: A comprehensive review of the current literature was done focusing on promising biomarkers related to aggressive prostate cancer. Summary of evidence: Combined with the heterogeneous nature of the disease, mixt case series are the most common study design, impeding robust results and the development of an effective therapeutic strategy. Improvement in prostate cancer patient survival requires not only the identification of new therapeutic target based on detailed understanding of the biological mechanisms involved in metastatic dissemination and tumor growth but strong clinical studies as well. Conclusion: Better study design involving potential markers and including well-classified and staged patients with robust methodology and adequate outcomes (mainly survival) are necessary to the field evolution. © 2011 AEU. Published by Elsevier España, S.L. All rights reserved.368484490Jemal, A., Siegel, R., Xu, J., Ward, E., Cancer statistics: 2010 (2010) CA Cancer J Clin, 60, pp. 277-300Reis, L.O., Old issues and new perspectives on prostate cancer hormonal therapy: The molecular substratum (2011) Med Oncol., , [Epub ahead of print]. 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