Evaluation of the Predictive Role of Blood-Based Biomarkers in the Context of Suspicious Prostate MRI in Patients Undergoing Prostate Biopsy

Abstract

The aim of this study was to assess the predictive value of pre-biopsy blood-based markers in patients undergoing a fusion biopsy for suspicious prostate magnetic resonance imaging (MRI). We identified 365 consecutive patients who underwent MRI-targeted and systematic prostate biopsy for an MRI scored Prostate Imaging–Reporting and Data System Version (PI-RADS) ≥ 3. We evaluated the neutrophil/lymphocyte ratio (NLR), derived neutrophil/lymphocyte ratio (dNLR), platelet/lymphocyte ratio (PLR), systemic immune inflammation index (SII), lymphocyte/monocyte ratio (LMR,) de Ritis ratio, modified Glasgow Prognostic Score (mGPS), and prognostic nutrition index (PNI). Uni- and multivariable logistic models were used to analyze the association of the biomarkers with biopsy findings. The clinical benefits of biomarkers implemented in clinical decision-making were assessed using decision curve analysis (DCA). In total, 69% and 58% of patients were diagnosed with any prostate cancer and Gleason Grade (GG) ≥ 2, respectively. On multivariable analysis, only high dNLR (odds ratio (OR) 2.61, 95% confidence interval (CI) 1.23–5.56, p = 0.02) and low PNI (OR 0.48, 95% CI 0.26–0.88, p = 0.02) remained independent predictors for GG ≥ 2. The logistic regression models with biomarkers reached AUCs of 0.824–0.849 for GG ≥ 2. The addition of dNLR and PNI did not enhance the net benefit of a standard clinical model. Finally, we created the nomogram that may help guide biopsy avoidance in patients with suspicious MRI. In patients with PI-RADS ≥ 3 lesions undergoing MRI-targeted and systematic biopsy, a high dNLR and low PNI were associated with unfavorable biopsy outcomes. Pre-biopsy blood-based biomarkers did not, however, significantly improve the discriminatory power and failed to add a clinical benefit beyond standard clinical factors.

Association between monocyte-to-lymphocyte ratio and prostate cancer in the U.S. population: a population-based study

“…However, some studies have also shown the limitations of MLR. A retrospective study by Pawel et al (Rajwa et al, 2021) concluded that MLR was not useful in the diagnosis of PCa. Racial differences in the association between MLR and PCa may also exist, as shown in a racially diverse study with a longer follow-up (Rundle et al, 2021).…”

A prospective study of the prostate health index density and multiparametric magnetic resonance imaging in diagnosing clinically significant prostate cancer

“…Nomograms combining PI-RADS score, age, and PSAD were also developed for csPCa prediction in patients with non-suspicious or equivocal mpMRI result (i.e., PI-RADS score ≤3) [ 27 ]. The predictive performance of the combination of other biomarkers has also been studied [ 28 ]. PHI and PHID were also attempted to further classify patients with positive mpMRI results [ 29 ].…”

The Clinical Utility of Systemic Immune-Inflammation Index Supporting Charlson Comorbidity Index and CAPRA-S Score in Determining Survival after Radical Prostatectomy—A Single Centre Study

“…Although in a preprostatectomy setting, the SII has not been confirmed as a predictor of unfavourable biopsy outcomes [ 35 ], recently the SII has been extensively validated in patients who have already undergone radical treatment. Similarly to other haematological markers, the SII can be easily retrieved and calculated from a full blood count, which is an obligatory part of preoperative laboratory evaluations.…”