Prostate cancer biomarkers and multiparametric MRI: is there a role for both in prostate cancer management?

Abstract

Several advancements have been made in recent years with regards to the detection and evaluation of prostate cancer (PCa). The low specificity of prostate specific antigen (PSA) has left much to be desired in a test, but a boom in novel biomarkers has made screening and surveillance more complicated. Several attempts at identifying a niche for these tests has helped somewhat, but much is still undetermined about the benefit that each test provides. In addition to laboratory tests, advancements in multiparametric magnetic resonance imaging (mpMRI) and PIRADSv.2 scoring have provided significant benefit to the evaluation of PCa. With the widespread use of prostate imaging, it is important to re-evaluate the impact of novel biomarkers in the context of furthering PCa screening and management. In this review, we aim to assess the influence mpMRI has on the role of nine different novel biomarkers in the detection and evaluation of PCa. We performed a review of current peer-reviewed literature to assess this question. Much data has been published on the role of these tests, allowing for their placement into one of three best-fit categories: tests for biopsy-naïve men (Prostate Health Index, Mi Prostate Score, 4K Score); tests for men with prior negative biopsies (ConfirmMDx, Progensa PCA3); and men on active surveillance (OncotypeDx, Prolaris, Decipher). Data on the role of these tests with the use of mpMRI have not been comprehensive and excludes several of the markers. More research is needed to determine the combined impact mpMRI and the novel biomarkers on the evaluation and management of PCa.

Prostate Cancer Radiogenomics—From Imaging to Molecular Characterization

“…ConfirmMDx ® is a tissue-based gene assay that screens for epigenetic modifications identified in a prostate tissue sample. Alterations in DNA methylation in tumor suppressor genes (GSTP1, GASSF1, and APC) are identified by this assay, with the aim to stratify the risk of men with prior negative biopsies [ 153 , 154 ]. An original research by Artenstein et al [ 149 ], using mpMRI PIRADS score lesions after ConfirmMDx ® sampling, indicates that a negative ConfirmMDx ® test was somehow in accordance with negative MRI results (71.4%).…”

Urinary PCA3 a Superior Diagnostic Biomarker for Prostate Cancer among Ghanaian Men

“…Multiparametric magnetic resonance imaging (mpMRI) with or without targeted biopsy has a well-established role in the detection of clinically significant PCa (csPCa) and an appealing alternative to transrectal ultrasonography (TRUS) biopsy [34][35][36] that was employed in this current study. Compared with systematic transrectal ultrasonographyguided biopsy, mpMRI is associated with a 57.0% improvement in the detection of clinically significant PCa and a 77% reduction in the number of cores taken per procedure [35,37]. Alkasab et al in evaluating the performance of PCA3 and MpMRI also reported an NPV of 40% and 83%, respectively.…”

Differentiating False Positive Lesions from Clinically Significant Cancer and Normal Prostate Tissue Using VERDICT MRI and Other Diffusion Models

“…Prostate cancer (PCa) is traditionally diagnosed via digital rectal inspection (DRE) and a prostate-specific antigen (PSA) test, followed by transrectal ultrasound (TRUS)-guided biopsy [ 1 ]. Multiparametric MRI (mp-MRI) has recently been introduced as a standard part of the prostate cancer clinical diagnosis pathway [ 2 ]—it consists of T1- and T2-weighted images, diffusion-weighted (DW) images and dynamic contrast-enhanced (DCE) imaging. This technique has high sensitivity (90%) but moderate specificity (50%), translating to a high rate of false positive cases [ 3 ].…”