Prospective assessment of two-gene urinary test with multiparametric magnetic resonance imaging of the prostate for men undergoing primary prostate biopsy

Busetto, Gian Maria; Giudice, Francesco Del; Maggi, Martina; Marco, Ferdinando De; Porreca, Angelo; Sperduti, Isabella; Magliocca, Fabio Massimo; Salciccia, Stefano; Chung, Benjamin I.; Berardinis, Ettore De; Sciarra, Alessandro

doi:10.1007/s00345-020-03359-w

Cited by 32 publications

(46 citation statements)

References 23 publications

(29 reference statements)

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“…Association of different PCa biomarkers with mpMRI findings is another interesting topic worth researching. The combination of biomarkers and mpMRI may result in more clinical benefit than PSA plus mpMRI, especially in those who had equivocal PI-RADS scores (49,57,58). Druskin et al recommended that prostate biopsy be performed in patients with PI-RADS ≥3 lesions in MRI or PHID ≥ 0.44 if PI-RADS score ≤2; this was 100% sensitive for csPCa detection (59).…”

Section: Discussionmentioning

confidence: 99%

Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection

Chiu

Cheng

et al. 2021

Front. Oncol.

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BackgroundProstate-specific antigen (PSA) is considered neither sensitive nor specific for prostate cancer (PCa). We aimed to compare total PSA (tPSA), percentage of free PSA (%fPSA), the PSA density (PSAD), Prostate Health Index (PHI), and the PHI density (PHID) to see which one could best predict clinically significant prostate cancer (csPCa): a potentially lethal disease.MethodsA total of 412 men with PSA of 2–20 ng/mL were prospectively included. Serum biomarkers for PCa was collected before transrectal ultrasound guided prostate biopsy. PHI was calculated by the formula: (p2PSA/fPSA) x √tPSA. PHID was calculated as PHI divided by prostate volume measured by transrectal ultrasound.ResultsOf the 412 men, 134 (32.5%) and 94(22.8%) were diagnosed with PCa and csPCa, respectively. We used the area under the receiver operating characteristic curve (AUC) and decision curve analyses (DCA) to compare the performance of PSA related parameters, PHI and PHID in diagnosing csPCa. AUC for tPSA, %fPSA, %p2PSA, PSAD, PHI and PHID were 0.56、0.63、0.76、0.74、0.77 and 0.82 respectively for csPCa detection. In the univariate analysis, the prostate volume, tPSA, %fPSA, %p2PSA, PHI, PSAD, and PHID were all significantly associated with csPCa, and PHID was the most important predictor (OR 1.41, 95% CI 1.15–1.72). Besides, The AUC of PHID was significantly larger than PHI in csPCa diagnosis (p=0.004). At 90% sensitivity, PHID had the highest specificity (54.1%) for csPCa and could reduce the most unnecessary biopsies (43.7%) and miss the fewest csPCa (8.5%) when PHID ≥ 0.67. In addition to AUC, DCA re-confirmed the clinical benefit of PHID over all PSA-related parameters and PHI in csPCa diagnosis. The PHID cut-off value was positively correlated with the csPCa ratio in the PHID risk table, which is useful for evaluating csPCa risk in a clinical setting.ConclusionThe PHID is an excellent predictor of csPCa. The PHID risk table may be used in standard clinical practice to pre-select men at the highest risk of harboring csPCa.

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Section: Discussionmentioning

confidence: 99%

Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection

Chiu

Cheng

et al. 2021

Front. Oncol.

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“…Although this area has benefited from mpMRI, the problem of overdiagnosis and the excessive number of unnecessary biopsies is still debated. In addition to PSA and its derivatives, a large number of new blood and urinary biomarkers to assist in biopsy decisions have appeared in clinical trials, largely thanks to advances in genomic technologies, among which the Prostate cancer antigen 3 (PCA3) [ 20 , 21 ], the SelectMDx multiplex biomarker [ 22 , 23 , 24 ], the ExoDx prostate Intelliscore [ 25 , 26 ], the Prostarix Risk Score [ 27 , 28 ], and the Prostate-specific G-protein coupled receptor (PSGR) [ 29 , 30 ]. However, their contribution in predicting biopsy outcomes needs to be more rigorously weighed.…”

Section: Discussionmentioning

confidence: 99%

Multiparametric Magnetic Resonance Imaging-Ultrasound Fusion Transperineal Prostate Biopsy: Diagnostic Accuracy from a Single Center Retrospective Study

Fulco

Chiaradia²,

Ascalone³

et al. 2021

Cancers

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The management of prostate biopsy in men with clinical suspicion of prostate cancer has changed in the last few years, especially with the introduction of imaging techniques, to overcome the low efficacy of risk stratification based on PSA levels. Here, we aimed to compare the diagnostic accuracy of multiparametric MRI with fusion ultrasound-guided prostate biopsy and standard biopsy, both performed through the transperineal route. To this end, we retrospectively analyzed 272 patients who underwent combined transperineal targeted and standard biopsy during the same session. The primary outcome was to compare the cancer detection rate between targeted and standard biopsy. The secondary outcome was to evaluate the added value of combined targeted and standard biopsy approach as compared to only targeted or standard biopsy. Results showed that a rate of 16.7% clinically significant tumors (International Society of Urological Pathology (ISUP) grade ≥ 2) would have been lost if only the standard biopsy had been used. The combined targeted and standard biopsy showed an added value of 10.3% and 9.9% in reducing the risk of prostate cancer missing after targeted or standard biopsy alone, respectively. The combined targeted and standard biopsy pathway is recommended to reduce the risk of missing clinically significant prostate cancer.

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“…Van Neste et al postulated that the use of this test could lead to a 42% decrease in the total number of biopsies carried out, with a 53% reduction in the number of unnecessary biopsies [ 172 ]. Further studies have shown that this test can help clinicians identify men at risk of clinically significant PC, thus aiding the initial biopsy decisions and helping to reduce the number of unnecessary biopsies [ 173 , 174 , 175 ]. Analyses have indicated that the use of SelectMDx before proceeding to biopsy could lead to an increase in quality-adjusted life years (a measure of disease burden that takes into account both the quantity and quality of life lived) while also saving healthcare costs [ 176 , 177 , 178 ].…”

Section: Alternative Diagnostic Biomarkers To Psamentioning

confidence: 99%

Tissue- and Liquid-Based Biomarkers in Prostate Cancer Precision Medicine

Meehan

Gray

Martínez-Pérez

et al. 2021

JPM

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Worldwide, prostate cancer (PC) is the second-most-frequently diagnosed male cancer and the fifth-most-common cause of all cancer-related deaths. Suspicion of PC in a patient is largely based upon clinical signs and the use of prostate-specific antigen (PSA) levels. Although PSA levels have been criticised for a lack of specificity, leading to PC over-diagnosis, it is still the most commonly used biomarker in PC management. Unfortunately, PC is extremely heterogeneous, and it can be difficult to stratify patients whose tumours are unlikely to progress from those that are aggressive and require treatment intensification. Although PC-specific biomarker research has previously focused on disease diagnosis, there is an unmet clinical need for novel prognostic, predictive and treatment response biomarkers that can be used to provide a precision medicine approach to PC management. In particular, the identification of biomarkers at the time of screening/diagnosis that can provide an indication of disease aggressiveness is perhaps the greatest current unmet clinical need in PC management. Largely through advances in genomic and proteomic techniques, exciting pre-clinical and clinical research is continuing to identify potential tissue, blood and urine-based PC-specific biomarkers that may in the future supplement or replace current standard practices. In this review, we describe how PC-specific biomarker research is progressing, including the evolution of PSA-based tests and those novel assays that have gained clinical approval. We also describe alternative diagnostic biomarkers to PSA, in addition to biomarkers that can predict PC aggressiveness and biomarkers that can predict response to certain therapies. We believe that novel biomarker research has the potential to make significant improvements to the clinical management of this disease in the near future.

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Prospective assessment of two-gene urinary test with multiparametric magnetic resonance imaging of the prostate for men undergoing primary prostate biopsy

Cited by 32 publications

References 23 publications

Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection

Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection

Multiparametric Magnetic Resonance Imaging-Ultrasound Fusion Transperineal Prostate Biopsy: Diagnostic Accuracy from a Single Center Retrospective Study

Tissue- and Liquid-Based Biomarkers in Prostate Cancer Precision Medicine

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