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Thomas J, Atluri S, Zucker I, Reis I, Kwon D, Kim E, Tewari A, Patel V, Wagaskar V, Konety B, Kasraeian A, Czarniecki S, Thoreson G, Soodana-Prakash N, Ritch C, Nahar B, Gonzalgo M, Kava B, Parekh D, Punnen S. A multi-institutional study of 1,111 men with 4K score, multiparametric magnetic resonance imaging, and prostate biopsy. Urol Oncol 2023; 41:430.e9-430.e16. [PMID: 37544833 DOI: 10.1016/j.urolonc.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/13/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Prostate magnetic resonance imaging (MRI) and biomarkers are often used in conjunction to enhance the selection process for prostate biopsy. However, the optimal sequence of ordering these tests has not been established. A comprehensive evaluation was conducted on a large multi-institutional cohort of patients who underwent MRI, 4K score, and biopsy of the prostate to examine the impact of utilizing both tests vs. either test alone and to determine if the order in which these tests are administered affects the ability to detect clinically significant prostate cancer (csCaP). METHODS AND MATERIALS We evaluated men from 8 different institutions who were referred for prostate cancer evaluation and underwent MRI, 4K score test, and prostate biopsy. The primary outcome was the presence of csCaP, defined as grade group 2 or higher cancer on a biopsy of the prostate. We used logistic regression, calibration plots, and decision curve analysis to evaluate using a 4K score or MRI alone vs. both tests together for detecting csCaP. In addition, we evaluated several strategies using one or both tests for selecting men for biopsy and compared them based on the proportion of biopsies avoided and the csCaP's missed. RESULTS Among the 1,111 men who formed the final cohort, 553 (49.8%) had prostate cancer, and 353 (31.8%) had csCaP. We found that using MRI and 4K score together had better discrimination, calibration, and a higher clinical utility on decision curve analysis compared to using either test individually. Using both tests together resulted in fewer biopsies avoided and missed cancers compared to using either test alone. Strategies that sequence MRI and 4K score tests resulted in the largest biopsy reduction, with no appreciable difference between starting with an MRI vs. a biomarker. CONCLUSIONS We found that using both an MRI and 4K score together was superior to using either test alone but found no appreciable difference between starting with an MRI vs. starting with a 4K score. Prospective studies are needed to identify the best strategy to sequence MRI and biomarkers in the evaluation of csCaP.
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Affiliation(s)
- Jamie Thomas
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL
| | - Shrikanth Atluri
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL
| | - Isaac Zucker
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL
| | - Isildinha Reis
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Deukwoo Kwon
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Eric Kim
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ashutosh Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vipul Patel
- Global Robotics Institute, Florida Hospital-Celebration Health, University of Central Florida College of Medicine, Orlando, FL
| | - Vinayak Wagaskar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Stefan Czarniecki
- HIFU Clinic, Department of Urology, St. Elizabeth Hospital, Warsaw, Poland
| | | | - Nachiketh Soodana-Prakash
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL
| | - Chad Ritch
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL
| | - Mark Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL
| | - Bruce Kava
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL
| | - Dipen Parekh
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine and Sylvester Cancer Center, Miami, FL.
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Jain G, Das P, Ranjan P, Neha, Valderrama F, Cieza-Borrella C. Urinary extracellular vesicles miRNA-A new era of prostate cancer biomarkers. Front Genet 2023; 14:1065757. [PMID: 36741322 PMCID: PMC9895092 DOI: 10.3389/fgene.2023.1065757] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
Prostate cancer is the second most common male cancer worldwide showing the highest rates of incidence in Western Europe. Although the measurement of serum prostate-specific antigen levels is the current gold standard in PCa diagnosis, PSA-based screening is not considered a reliable diagnosis and prognosis tool due to its lower sensitivity and poor predictive score which lead to a 22%-43% overdiagnosis, unnecessary biopsies, and over-treatment. These major limitations along with the heterogeneous nature of the disease have made PCa a very unappreciative subject for diagnostics, resulting in poor patient management; thus, it urges to identify and validate new reliable PCa biomarkers that can provide accurate information in regard to disease diagnosis and prognosis. Researchers have explored the analysis of microRNAs (miRNAs), messenger RNAs (mRNAs), small proteins, genomic rearrangements, and gene expression in body fluids and non-solid tissues in search of lesser invasive yet efficient PCa biomarkers. Although the presence of miRNAs in body fluids like blood, urine, and saliva initially sparked great interest among the scientific community; their potential use as liquid biopsy biomarkers in PCa is still at a very nascent stage with respect to other well-established diagnostics and prognosis tools. Up to date, numerous studies have been conducted in search of PCa miRNA-based biomarkers in whole blood or blood serum; however, only a few studies have investigated their presence in urine samples of which less than two tens involve the detection of miRNAs in extracellular vesicles isolated from urine. In addition, there exists some discrepancy around the identification of miRNAs in PCa urine samples due to the diversity of the urine fractions that can be targeted for analysis such as urine circulating cells, cell-free fractions, and exosomes. In this review, we aim to discuss research output from the most recent studies involving the analysis of urinary EVs for the identification of miRNA-based PCa-specific biomarkers.
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Affiliation(s)
- Garima Jain
- Centre for Genetic Disorders, Institute of Science, Banaras Hindu University, Varanasi, India,*Correspondence: Garima Jain, ; Clara Cieza-Borrella,
| | - Parimal Das
- Centre for Genetic Disorders, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Prashant Ranjan
- Centre for Genetic Disorders, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Neha
- Centre for Genetic Disorders, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Ferran Valderrama
- Centre for Biomedical Education, Cell Biology and Genetics Research Centre, St. George’s University of London, London, United Kingdom
| | - Clara Cieza-Borrella
- Centre for Biomedical Education, Cell Biology and Genetics Research Centre, St. George’s University of London, London, United Kingdom,*Correspondence: Garima Jain, ; Clara Cieza-Borrella,
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Baboudjian M, Roumiguié M, Peltier A, Oderda M, Barret E, Fromont G, Dariane C, Fiard G, Charvet AL, Gondran-Tellier B, Durand-Labrunie C, Campello PV, Roumeguère T, Diamand R, Diana P, Touzani A, Beauval JB, Daniel L, Rouprêt M, Ruffion A, Ploussard G. Grade group 1 prostate cancer on biopsy: are we still missing aggressive disease in the era of image-directed therapy? World J Urol 2022; 40:2423-2429. [PMID: 35980449 DOI: 10.1007/s00345-022-04130-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Recently, Eggener et al. reignited a debate consisting to redefine Gleason Grade Group (GGG) 1 prostate cancer (PCa) as a precancerous lesion to reduce overdiagnosis and overtreatment. However, historical cohorts showed that some GGG1-labeled disease at biopsy may be underestimated by the standard PCa diagnostic workup. The aim was to assess whether the risk of adverse features at radical prostatectomy (RP) in selected GGG1 patients still exists in the era of pre-biopsy mpMRI and image-guided biopsies. METHODS We retrospectively reviewed our data from a European RP dataset to assess in contemporary patients with GGG1 at mpMRI-targeted biopsy the rate of adverse features at final pathology, defined as ≥ pT3a and/or pN+ and/or GGG ≥ 3. RESULTS A total of 419 patients with cT1-T2 cN0 GGG1-PCa were included. At final pathology, 143 (34.1%) patients had adverse features. In multivariate analysis, only unfavorable intermediate-risk/high-risk disease (defined on PSA or stage) was predictive of adverse features (OR 2.45, 95% CI 1.11-5.39, p = 0.02). A significant difference was observed in the 3-year biochemical recurrence-free survival between patients with and without adverse features (93.4 vs 87.8%, p = 0.026). In sensitivity analysis restricted low- and favorable intermediate-risk PCa, 122/383 patients (31.8%) had adverse features and no preoperative factors were statistically associated with this risk. CONCLUSION In this European study, we showed that there is still a risk of underestimating GGG1 disease at biopsy despite the routine use of image-guided biopsies. Future studies are warranted to improve the detection of aggressive disease in GGG1-labeled patients by incorporating the latest tools such as genomic testing or radiomics.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
- Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France.
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France.
| | - Mathieu Roumiguié
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | - Alexandre Peltier
- Department of Urology, Hôpital Universitaire de Bruxelles, Jules Bordet Institute and Erasme Hopsital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marco Oderda
- Division of Urology, Department of Surgical Sciences-Urology, Città Della Salute e della Scienza di Torino-Molinette Hospital, University of Turin, Turin, Italy
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, APHP, ParisParis University-U1151 Inserm-INEM, Necker, Paris, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
| | - Anne-Laure Charvet
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Bastien Gondran-Tellier
- Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France
| | | | | | - Thierry Roumeguère
- Department of Urology, Hôpital Universitaire de Bruxelles, Jules Bordet Institute and Erasme Hopsital, Université Libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, Hôpital Universitaire de Bruxelles, Jules Bordet Institute and Erasme Hopsital, Université Libre de Bruxelles, Brussels, Belgium
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alae Touzani
- Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | | | - Laurent Daniel
- Department of Pathology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, 75013, Paris, France
| | - Alain Ruffion
- Service d'urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon,, Lyon, France
- Equipe 2-Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud-Université Lyon 1, Lyon, France
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Wang X, Jordahl KM, Zhu C, Livingstone J, Rhie SK, Wright JL, Grady WM, Boutros PC, Stanford JL, Dai JY. Methylation Subtypes of Primary Prostate Cancer Predict Poor Prognosis. Cancer Epidemiol Biomarkers Prev 2022; 31:1473-1482. [PMID: 35437583 PMCID: PMC9250603 DOI: 10.1158/1055-9965.epi-22-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Patients with prostate cancer experience heterogeneous outcomes after radical prostatectomy. Genomic studies including The Cancer Genome Atlas (TCGA) have reported molecular signatures of prostate cancer, but few studies have assessed the prognostic effects of DNA methylation profiles. METHODS We conducted the largest methylome subtyping analysis for primary prostate tumors to date, using methylome data from three patient populations: TCGA, a prostate cancer cohort study conducted at the Fred Hutchinson Cancer Research Center (FH; Seattle, WA), and the Canadian International Cancer Genome Consortium (ICGC) cohort. Four subtypes were detected in the TCGA dataset, then independently assigned to FH and ICGC cohort data. The identified methylation subtypes were assessed for association with cancer prognosis in the above three patient populations. RESULTS Using a set of hypermethylated CpG sites, four methylation subtypes were identified in TCGA. Compared with subtype 1, subtype 4 had an HR of 2.09 (P = 0.029) for biochemical recurrence (BCR) in TCGA patients. HRs of 2.76 (P = 0.002) for recurrence and 9.73 (P = 0.002) for metastatic-lethal (metastasis or prostate cancer-specific death) outcomes were observed in the FH cohort. A similar pattern of association was noted in the Canadian ICGC cohort, though HRs were not statistically significant. CONCLUSIONS A hypermethylated subtype was associated with an increased hazard of recurrence and mortality in three studies with prostate tumor methylome data. Further molecular work is needed to understand the effect of methylation subtypes on cancer prognosis. IMPACT This study identified a DNA methylation subtype that was associated with worse prostate cancer prognosis after radical prostatectomy.
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Affiliation(s)
- Xiaoyu Wang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kristina M. Jordahl
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Chenghao Zhu
- Department of Human Genetics, University of California, Los Angeles, CA, USA
- Department of Urology, University of California, Los Angeles, CA, USA
- Institute for Precision Health, University of California, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, CA, USA
| | - Julie Livingstone
- Department of Human Genetics, University of California, Los Angeles, CA, USA
- Department of Urology, University of California, Los Angeles, CA, USA
- Institute for Precision Health, University of California, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, CA, USA
| | - Suhn K. Rhie
- Department of Biochemistry and Molecular Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jonathan L. Wright
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - William M. Grady
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Paul C. Boutros
- Department of Human Genetics, University of California, Los Angeles, CA, USA
- Department of Urology, University of California, Los Angeles, CA, USA
- Institute for Precision Health, University of California, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, CA, USA
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Janet L. Stanford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - James Y. Dai
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
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