The Roles of Multiparametric Magnetic Resonance Imaging, PCA3 and Prostate Health Index—Which is the Best Predictor of Prostate Cancer after a Negative Biopsy?

Abstract

Purpose: In patients with a negative prostate biopsy and persistent suspicion of prostate cancer, additional analyses such as the PCA3 score, PHI and multiparametric magnetic resonance imaging have been proposed to reduce the number of unnecessary repeat biopsies. In this study we evaluate the diagnostic accuracy of PCA3, PHI, multiparametric magnetic resonance imaging and various combinations of these tests in the repeat biopsy setting. Materials and Methods: A total of 170 patients with an initial negative prostate biopsy and persistent suspicion of prostate cancer were enrolled in this prospective study. The patients underwent measurements of the total prostate specific antigen and free prostate specific antigen rate, along with PHI, PCA3 tests and multiparametric magnetic resonance imaging before standard repeat biopsy that was performed by urologists blinded to the multiparametric magnetic resonance imaging results. Multivariate logistic regression models with various combinations of PCA3, PHI and multiparametric magnetic resonance imaging were used to identify the predictors of prostate cancer with repeat biopsy, and the performance of these models was compared using ROC curves, AUC analysis and decision curve analysis. Results: In the ROC analysis the most significant contribution was provided by multiparametric magnetic resonance imaging (AUC 0.936), which was greater than the contribution of the PHIþPCA3 model (p <0.001). In the multivariate logistic regression analysis only multiparametric magnetic resonance imaging was a significant independent predictor of prostate cancer diagnosis with repeat biopsy (p <0.001). The results of the decision curve analysis confirmed that the most significant improvement in the net benefit was provided by multiparametric magnetic resonance imaging.

The clinical effectiveness and cost-effectiveness of the PROGENSA® prostate cancer antigen 3 assay and the Prostate Health Index in the diagnosis of prostate cancer: a systematic review and economic evaluation

“…A total of 21 papers 45,46,85,86,[88][89][90][91][92][94][95][96][97][98][99][101][102][103][104][105][106] were identified which reported within-study comparisons between clinical assessment + PCA3 and/or clinical assessment + phi versus a comparator.…”

“…Fourteen studies 45,46,85,86,[89][90][91][92][94][95][96][97]99,[102][103][104][105][106] were observational cohort studies and one was a randomised controlled trial (RCT). 103 Eleven studies were of a prospective cohort design, 45,46,85,86,89,90,92,94,97,99,102,103 three studies 91,95,96,106 were of a retrospective cohort design and one study 104 was of mixed design.…”

“…103 Eleven studies were of a prospective cohort design, 45,46,85,86,89,90,92,94,97,99,102,103 three studies 91,95,96,106 were of a retrospective cohort design and one study 104 was of mixed design. None of the studies was based in the UK; the relevance of the included study results to UK clinical practice is, therefore, uncertain.…”

“…Among cases for which details were provided, 10-or 12-core biopsies were the most common. Three studies 96,99,102 exploring the efficacy of the PCA3 score and all four studies 92,99,102,104 exploring the efficacy of phi used saturation biopsies or reported that the mean or median number of cores taken was 20 or more. The repeat biopsy was usually performed transrectally under ultrasonography guidance, taking 10-20 cores.…”

The way of prostate cancer diagnostics

“…Thus, the time of prostate biomarkers is not over but it should be used in combination with the MRI in an appropriate strategy. So far, there is only one study that compared MRI, PHI and PCA3 with an advantage for the MRI but no PIRADS score was used [14]. Further comparisons of the established and new biomarkers with the MRI are necessary to find the best possible PCa diagnostic pathway of the future.…”