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Campistol M, Triquell M, Regis L, Celma A, de Torres I, Semidey ME, Mast R, Mendez O, Planas J, Trilla E, Morote J. Relationship between Proclarix and the Aggressiveness of Prostate Cancer. Mol Diagn Ther 2023; 27:487-498. [PMID: 37081322 DOI: 10.1007/s40291-023-00649-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Proclarix is a CE-marked test that provides the risk of clinically significant prostate cancer (csPCa), ranging from 0% to 100%, based on the serum measurement of Thrombospondin-1, cathepsin D, prostate-specific antigen (PSA), and percentage of free PSA in addition to age. We hypothesize that Proclarix could be correlated with PCa aggressiveness. We analyzed the association of this new biomarker with four surrogates of aggressiveness: grade group (GG) in the biopsy, clinical stage, risk of biochemical recurrence after primary treatment of localized PCa, and pathology in the surgical specimen. MATERIAL AND METHODS This is a retrospective study from 606 men with suspicion of PCa [PSA of ≥ 3.0 ng/mL and/or abnormal digital rectal examination (DRE)], in whom Proclarix was assessed (0-100%). The GG was defined by the International Society of Urological Pathology categories. The TNM was used for clinical staging (cT based on DRE, whereas cN and cM were established with computed tomography and 99-technetium bone scintigraphy). The risk of biochemical recurrence of localized PCa after primary treatment was defined by combining PSA, GG, and cT. Finally, an unfavorable pathology in a surgical specimen was defined as GG > 2 or pT ≥ 3. RESULTS The median age of the cohort was 67 years old, with a median PSA of 7 ng/mL and a rate of abnormal DRE of 23.3%. CsPCa was detected in 254 men (41.9%), with a median Proclarix of 60.1% compared with 37.3% obtained in patients with insignificant PCa and 20.7% in men without PCa. Among patients with GG > 3, Proclarix was significantly higher (58.2%) than in those with GG of 3 or lower (33.1%, p < 0.001). Men with localized tumors exhibited a Proclarix median of 37.3% compared with those with advanced disease (60.1%, p < 0.001). Proclarix levels among 197 patients with low and intermediate risk of biochemical recurrence were 24.9% and 35.0%, respectively, significantly lower compared with patients with high-risk disease (58.7%, p < 0.001). Unfavorable pathology was observed in 35 patients out of the 79 who underwent radical prostatectomy, with a Proclarix median of 35.7% compared with 23.7% obtained in patients with favorable pathology (p = 0.013). Proclarix and magnetic resonance imaging were independent predictors of the four surrogates of aggressiveness analyzed. CONCLUSION There is a correlation between Proclarix and the aggressiveness of PCa.
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Affiliation(s)
- Miriam Campistol
- Department of Urology, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain.
- Department of Surgery, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain.
| | - Marina Triquell
- Department of Urology, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Lucas Regis
- Department of Urology, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
- Prostate Cancer Research Group, Vall d'Hebron, Research Institute, 08035, Barcelona, Spain
| | - Ana Celma
- Department of Urology, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
- Prostate Cancer Research Group, Vall d'Hebron, Research Institute, 08035, Barcelona, Spain
| | - Inés de Torres
- Prostate Cancer Research Group, Vall d'Hebron, Research Institute, 08035, Barcelona, Spain
- Department of Pathology, Vall d'Hebron Hospital, 08035, Barcelona, Spain
- Department of Morphological Sciences, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
| | - María E Semidey
- Prostate Cancer Research Group, Vall d'Hebron, Research Institute, 08035, Barcelona, Spain
- Department of Pathology, Vall d'Hebron Hospital, 08035, Barcelona, Spain
- Department of Morphological Sciences, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
| | - Richard Mast
- Department of Radiology, Vall d'Hebron Hospital, 08035, Barcelona, Spain
| | - Olga Mendez
- Prostate Cancer Research Group, Vall d'Hebron, Research Institute, 08035, Barcelona, Spain
| | - Jacques Planas
- Department of Urology, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
- Prostate Cancer Research Group, Vall d'Hebron, Research Institute, 08035, Barcelona, Spain
| | - Enrique Trilla
- Department of Urology, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
- Prostate Cancer Research Group, Vall d'Hebron, Research Institute, 08035, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
| | - Juan Morote
- Department of Urology, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain
- Prostate Cancer Research Group, Vall d'Hebron, Research Institute, 08035, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
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A Clinically Significant Prostate Cancer Predictive Model Using Digital Rectal Examination Prostate Volume Category to Stratify Initial Prostate Cancer Suspicion and Reduce Magnetic Resonance Imaging Demand. Cancers (Basel) 2022; 14:cancers14205100. [PMID: 36291883 PMCID: PMC9600141 DOI: 10.3390/cancers14205100] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
A predictive model including age, PCa family history, biopsy status (initial vs repeat), DRE (normal vs abnormal), serum prostate-specific antigen (PSA), and DRE prostate volume ca-tegory was developed to stratify initial PCa suspicion in 1486 men with PSA > 3 ng/mL and/or abnormal DRE, in whom mpMRI followed; 2- to 4-core TRUS-guided biopsies where Prostate Imaging Report and Data System (PI-RADS) > 3 lesions and/or 12-core TRUS systematic biopsies were performed in one academic institution between 1 January 2016−31 December 2019. The csPCa detection rate, defined as International Society of Uro-Pathology grade group 2 or higher, was 36.9%. An external validation of designed BCN-RC 1 was carried out on 946 men from two other institutions in the same metropolitan area, using the same criteria of PCa suspicion and diagnostic approach, yielded a csPCa detection rate of 40.8%. The areas under the receiver operating characteristic curves of BCN-RC 1 were 0.823 (95% CI: 0.800−0.846) in the development cohort and 0.837 (95% CI: 0.811−0.863) in the validation cohort (p = 0.447). In both cohorts, BCN-RC 1 exhibited net benefit over performing mpMRI in all men from 8 and 12% risk thresholds, respectively. At 0.95 sensitivity of csPCa, the specificities of BCN-RC 1 were 0.24 (95% CI: 0.22−0.26) in the development cohort and 0.34 (95% CI: 0.31−0.37) in the validation cohort (p < 0.001). The percentages of avoided mpMRI scans were 17.2% in the development cohort and 22.3% in the validation cohort, missing between 1.8% and 2% of csPCa among men at risk of PCa. In summary, BCN-RC 1 can stratify initial PCa suspicion, reducing the demand of mpMRI, with an acceptable loss of csPCa.
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Magnetic Resonance Imaging-Based Predictive Models for Clinically Significant Prostate Cancer: A Systematic Review. Cancers (Basel) 2022; 14:cancers14194747. [PMID: 36230670 PMCID: PMC9562712 DOI: 10.3390/cancers14194747] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Magnetic resonance imaging (MRI) has allowed the early detection of PCa to evolve towards clinically significant PCa (csPCa), decreasing unnecessary prostate biopsies and overdetection of insignificant tumours. MRI identifies suspicious lesions of csPCa, predicting the semi-quantitative risk through the prostate imaging report and data system (PI-RADS), and enables guided biopsies, increasing the sensitivity of csPCa. Predictive models that individualise the risk of csPCa have also evolved adding PI-RADS score (MRI-PMs), improving the selection of candidates for prostate biopsy beyond the PI-RADS category. During the last five years, many MRI-PMs have been developed. Our objective is to analyse the current developed MRI-PMs and define their clinical usefulness through a systematic review. We have found high heterogeneity between MRI technique, PI-RADS versions, biopsy schemes and approaches, and csPCa definitions. MRI-PMs outperform the selection of candidates for prostate biopsy beyond MRI alone and PMs based on clinical predictors. However, few developed MRI-PMs are externally validated or have available risk calculators (RCs), which constitute the appropriate requirements used in routine clinical practice. Abstract MRI can identify suspicious lesions, providing the semi-quantitative risk of csPCa through the Prostate Imaging-Report and Data System (PI-RADS). Predictive models of clinical variables that individualise the risk of csPCa have been developed by adding PI-RADS score (MRI-PMs). Our objective is to analyse the current developed MRI-PMs and define their clinical usefulness. A systematic review was performed after a literature search performed by two independent investigators in PubMed, Cochrane, and Web of Science databases, with the Medical Subjects Headings (MESH): predictive model, nomogram, risk model, magnetic resonance imaging, PI-RADS, prostate cancer, and prostate biopsy. This review was made following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria and studied eligibility based on the Participants, Intervention, Comparator, and Outcomes (PICO) strategy. Among 723 initial identified registers, 18 studies were finally selected. Warp analysis of selected studies was performed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Clinical predictors in addition to the PI-RADS score in developed MRI-PMs were age, PCa family history, digital rectal examination, biopsy status (initial vs. repeat), ethnicity, serum PSA, prostate volume measured by MRI, or calculated PSA density. All MRI-PMs improved the prediction of csPCa made by clinical predictors or imaging alone and achieved most areas under the curve between 0.78 and 0.92. Among 18 developed MRI-PMs, 7 had any external validation, and two RCs were available. The updated PI-RADS version 2 was exclusively used in 11 MRI-PMs. The performance of MRI-PMs according to PI-RADS was only analysed in a single study. We conclude that MRI-PMs improve the selection of candidates for prostate biopsy beyond the PI-RADS category. However, few developed MRI-PMs meet the appropriate requirements in routine clinical practice.
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Morote J, Planas J, Trilla E. Re: Magdalena Görtz, Jan Philipp Radtke, Gencay Hatiboglu, et al. The Value of Prostate-specific Antigen Density for Prostate Imaging-Reporting and Data System 3 Lesions on Multiparametric Magnetic Resonance Imaging: A Strategy to Avoid Unnecessary Prostate Biopsies. Eur Urol Focus 2021;7:325-31. Eur Urol Focus 2022; 8:1557-1558. [PMID: 34992001 DOI: 10.1016/j.euf.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Juan Morote
- Department of Urology, Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Jacques Planas
- Department of Urology, Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enrique Trilla
- Department of Urology, Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Campistol M, Morote J, Triquell M, Regis L, Celma A, de Torres I, Semidey ME, Mast R, Santamaría A, Planas J, Trilla E. Comparison of Proclarix, PSA Density and MRI-ERSPC Risk Calculator to Select Patients for Prostate Biopsy after mpMRI. Cancers (Basel) 2022; 14:cancers14112702. [PMID: 35681685 PMCID: PMC9179369 DOI: 10.3390/cancers14112702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023] Open
Abstract
Tools to properly select candidates for prostate biopsy after magnetic resonance imaging (MRI) have usually been analyzed in overall populations with suspected prostate cancer (PCa). However, the performance of these tools can change regarding the Prostate Imaging-Reporting and Data System (PI-RADS) categories due to the different incidence of clinically significant PCa (csPCa). The objective of the study was to analyze PSA density (PSAD), MRI-ERSPC risk calculator (RC), and Proclarix to properly select candidates for prostate biopsy regarding PI-RADS categories. We performed a head-to-head analysis of 567 men with suspected PCa, PSA > 3 ng/mL and/or abnormal rectal examination, in whom two to four core transrectal ultrasound (TRUS) guided biopsies to PI-RADS ≥ three lesions and/or 12-core TRUS systematic biopsies were performed after 3-tesla mpMRI between January 2018 and March 2020 in one academic institution. The overall detection of csPCa was 40.9% (6% in PI-RADS < 3, 14.8% in PI-RADS 3, 55.3% in PI-RADS 4, and 88.9% in PI-RADS 5). MRI-ERSPC model exhibited a net benefit over PSAD and Proclarix in the overall population. Proclarix outperformed PSAD and MRI-ERSPC RC in PI-RADS ≤ 3. PSAD outperformed MRI-ESRPC RC and Proclarix in PI-RADS > 3, although none of them exhibited 100% sensitivity for csPCa in this setting. Therefore, tools to properly select candidates for prostate biopsy after MRI must be analyzed regarding the PI-RADS categories. While MRI-ERSPC RC outperformed PSAD and Proclarix in the overall population, Proclarix outperformed in PI-RADS ≤ 3, and no tool guaranteed 100% detection of csPCa in PI-RADS 4 and 5.
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Affiliation(s)
- Miriam Campistol
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (J.M.); (M.T.); (L.R.); (A.C.); (J.P.); (E.T.)
- Correspondence: ; Tel.: +34-6969-04272
| | - Juan Morote
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (J.M.); (M.T.); (L.R.); (A.C.); (J.P.); (E.T.)
- Prostate Cancer Research Group, Vall d’Hebron, Research Institute, 08035 Barcelona, Spain; (I.d.T.); (M.E.S.); (A.S.)
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Marina Triquell
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (J.M.); (M.T.); (L.R.); (A.C.); (J.P.); (E.T.)
| | - Lucas Regis
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (J.M.); (M.T.); (L.R.); (A.C.); (J.P.); (E.T.)
- Prostate Cancer Research Group, Vall d’Hebron, Research Institute, 08035 Barcelona, Spain; (I.d.T.); (M.E.S.); (A.S.)
| | - Ana Celma
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (J.M.); (M.T.); (L.R.); (A.C.); (J.P.); (E.T.)
- Prostate Cancer Research Group, Vall d’Hebron, Research Institute, 08035 Barcelona, Spain; (I.d.T.); (M.E.S.); (A.S.)
| | - Inés de Torres
- Prostate Cancer Research Group, Vall d’Hebron, Research Institute, 08035 Barcelona, Spain; (I.d.T.); (M.E.S.); (A.S.)
- Department of Pathology, Vall d’Hebron Hospital, 08035 Barcelona, Spain
- Department of Morphological Sciences, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - María E. Semidey
- Prostate Cancer Research Group, Vall d’Hebron, Research Institute, 08035 Barcelona, Spain; (I.d.T.); (M.E.S.); (A.S.)
- Department of Pathology, Vall d’Hebron Hospital, 08035 Barcelona, Spain
- Department of Morphological Sciences, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Richard Mast
- Department of Radiology, Vall d’Hebron Hospital, 08035 Barcelona, Spain;
| | - Anna Santamaría
- Prostate Cancer Research Group, Vall d’Hebron, Research Institute, 08035 Barcelona, Spain; (I.d.T.); (M.E.S.); (A.S.)
| | - Jacques Planas
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (J.M.); (M.T.); (L.R.); (A.C.); (J.P.); (E.T.)
- Prostate Cancer Research Group, Vall d’Hebron, Research Institute, 08035 Barcelona, Spain; (I.d.T.); (M.E.S.); (A.S.)
| | - Enrique Trilla
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (J.M.); (M.T.); (L.R.); (A.C.); (J.P.); (E.T.)
- Prostate Cancer Research Group, Vall d’Hebron, Research Institute, 08035 Barcelona, Spain; (I.d.T.); (M.E.S.); (A.S.)
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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Comparative Analysis of PSA Density and an MRI-Based Predictive Model to Improve the Selection of Candidates for Prostate Biopsy. Cancers (Basel) 2022; 14:cancers14102374. [PMID: 35625978 PMCID: PMC9139805 DOI: 10.3390/cancers14102374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/28/2022] [Accepted: 05/09/2022] [Indexed: 02/01/2023] Open
Abstract
This study is a head-to-head comparison between mPSAD and MRI-PMbdex. The MRI-PMbdex was created from 2432 men with suspected PCa; this cohort comprised the development and external validation cohorts of the Barcelona MRI predictive model. Pre-biopsy 3-Tesla multiparametric MRI (mpMRI) and 2 to 4-core transrectal ultrasound (TRUS)-guided biopsies for suspicious lesions and/or 12-core TRUS systematic biopsies were scheduled. Clinically significant PCa (csPCa), defined as Gleason-based Grade Group 2 or higher, was detected in 934 men (38.4%). The area under the curve was 0.893 (95% confidence interval [CI]: 0.880−0.906) for MRI-PMbdex and 0.764 (95% CI: 0.774−0.783) for mPSAD, with p < 0.001. MRI-PMbdex showed net benefit over biopsy in all men when the probability of csPCa was greater than 2%, while mPSAD did the same when the probability of csPCa was greater than 18%. Thresholds of 13.5% for MRI-PMbdex and 0.628 ng/mL2 for mPSAD had 95% sensitivity for csPCa and presented 51.1% specificity for MRI-PMbdex and 19.6% specificity for mPSAD, with p < 0.001. MRI-PMbdex exhibited net benefit over mPSAD in men with prostate imaging report and data system (PI-RADS) <4, while neither exhibited any benefit in men with PI-RADS 5. Hence, we can conclude that MRI-PMbdex is more accurate than mPSAD for the proper selection of candidates for prostate biopsy among men with suspected PCa, with the exception of men with a PI-RAD S 5 score, for whom neither tool exhibited clinical guidance to determine the need for biopsy.
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Morote J, Borque-Fernando A, Triquell M, Celma A, Regis L, Escobar M, Mast R, de Torres IM, Semidey ME, Abascal JM, Sola C, Servian P, Salvador D, Santamaría A, Planas J, Esteban LM, Trilla E. The Barcelona Predictive Model of Clinically Significant Prostate Cancer. Cancers (Basel) 2022; 14:cancers14061589. [PMID: 35326740 PMCID: PMC8946272 DOI: 10.3390/cancers14061589] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
A new and externally validated MRI-PM for csPCa was developed in the metropolitan area of Barcelona, and a web-RC designed with the new option of selecting the csPCa probability threshold. The development cohort comprised 1486 men scheduled to undergo a 3-tesla multiparametric MRI (mpMRI) and guided and/or systematic biopsies in one academic institution of Barcelona. The external validation cohort comprised 946 men in whom the same diagnostic approach was carried out as in the development cohort, in two other academic institutions of the same metropolitan area. CsPCa was detected in 36.9% of men in the development cohort and 40.8% in the external validation cohort (p = 0.054). The area under the curve of mpMRI increased from 0.842 to 0.897 in the developed MRI-PM (p < 0.001), and from 0.743 to 0.858 in the external validation cohort (p < 0.001). A selected 15% threshold avoided 40.1% of prostate biopsies and missed 5.4% of the 36.9% csPCa detected in the development cohort. In men with PI-RADS <3, 4.3% would be biopsied and 32.3% of all existing 4.2% of csPCa would be detected. In men with PI-RADS 3, 62% of prostate biopsies would be avoided and 28% of all existing 12.4% of csPCa would be undetected. In men with PI-RADS 4, 4% of prostate biopsies would be avoided and 0.6% of all existing 43.1% of csPCa would be undetected. In men with PI-RADS 5, 0.6% of prostate biopsies would be avoided and none of the existing 42.0% of csPCa would be undetected. The Barcelona MRI-PM presented good performance on the overall population; however, its clinical usefulness varied regarding the PI-RADS category. The selection of csPCa probability thresholds in the designed RC may facilitate external validation and outperformance of MRI-PMs in specific PI-RADS categories.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (M.T.); (A.C.); (L.R.); (J.P.); (E.T.)
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Correspondence: ; Tel.: +34-9327-46009
| | - Angel Borque-Fernando
- Department of Urology, Hospital Universitario Miguel Servet, IIS-Aragon, 50009 Zaragoza, Spain;
| | - Marina Triquell
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (M.T.); (A.C.); (L.R.); (J.P.); (E.T.)
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Anna Celma
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (M.T.); (A.C.); (L.R.); (J.P.); (E.T.)
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Lucas Regis
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (M.T.); (A.C.); (L.R.); (J.P.); (E.T.)
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Manel Escobar
- Department of Radiology, Vall d´Hebron Hospital, 08035 Barcelona, Spain; (M.E.); (R.M.)
| | - Richard Mast
- Department of Radiology, Vall d´Hebron Hospital, 08035 Barcelona, Spain; (M.E.); (R.M.)
| | - Inés M. de Torres
- Department of Pathology, Vall d´Hebron Hospital, 08035 Barcelona, Spain; (I.M.d.T.); (M.E.S.)
- Department of Morphological Sciences, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - María E. Semidey
- Department of Pathology, Vall d´Hebron Hospital, 08035 Barcelona, Spain; (I.M.d.T.); (M.E.S.)
- Department of Morphological Sciences, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - José M. Abascal
- Department of Urology, Parc de Salut Mar, 08003 Barcelona, Spain; (J.M.A.); (C.S.)
| | - Carles Sola
- Department of Urology, Parc de Salut Mar, 08003 Barcelona, Spain; (J.M.A.); (C.S.)
| | - Pol Servian
- Department of Urology, Hospital Germans Trias I Pujol, 08916 Badalona, Spain; (P.S.); (D.S.)
| | - Daniel Salvador
- Department of Urology, Hospital Germans Trias I Pujol, 08916 Badalona, Spain; (P.S.); (D.S.)
| | - Anna Santamaría
- Urology Research Group, Vall d´ Hebron Research Institute, 08035 Barcelona, Spain;
| | - Jacques Planas
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (M.T.); (A.C.); (L.R.); (J.P.); (E.T.)
| | - Luis M. Esteban
- Department of Applied Mathematics, Escuela Universitaria Politécnica La Almunia, Universidad de Zaragoza, 50100 Zaragoza, Spain;
| | - Enrique Trilla
- Department of Urology, Vall d’Hebron Hospital, 08035 Barcelona, Spain; (M.T.); (A.C.); (L.R.); (J.P.); (E.T.)
- Department of Surgery, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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Morote J, Campistol M, Triquell M, Celma A, Regis L, de Torres I, Semidey ME, Mast R, Santamaria A, Planas J, Trilla E. Improving the Early Detection of Clinically Significant Prostate Cancer in Men in the Challenging Prostate Imaging-Reporting and Data System 3 Category. EUR UROL SUPPL 2022; 37:38-44. [PMID: 35243388 PMCID: PMC8883194 DOI: 10.1016/j.euros.2021.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background Prostate Imaging-Reporting and Data System (PI-RADS) category 3 is a challenging scenario for detection of clinically significant prostate cancer (csPCa) and some tools can improve the selection of appropriate candidates for prostate biopsy. Objective To assess the performance of the European Randomized Study of Screening for Prostate Cancer (ERSPC) magnetic resonance imaging (MRI) model, the new Proclarix test, and prostate-specific antigen density (PSAD) in selecting candidates for prostate biopsy among men in the PI-RADS 3 category. Design, setting, and participants We conducted a head-to-head prospective analysis of 567 men suspected of having PCa for whom guided and systematic biopsies were scheduled between January 2018 and March 2020 in a single academic institution. A PI-RADS v.2 category 3 lesion was identified in 169 men (29.8%). Outcome measurement and statistical analysis csPCa, insignificant PCa (iPCa), and unnecessary biopsy rates were analysed. csPCa was defined as grade group ≥2. Receiver operating characteristic (ROC) curves, decision curve analysis curves, and clinical utility curves were plotted. Results and limitations PCa was detected in 53/169 men (31.4%) with a PI-RADS 3 lesion, identified as csPCa in 25 (14.8%) and iPCa in 28 (16.6%). The area under the ROC curve for csPCa detection was 0.703 (95% confidence interval [CI] 0.621–0.768) for Proclarix, 0.657 (95% CI 0.547–0.766) for the ERSPC MRI model, and 0.612 (95% CI 0.497–0.727) for PSAD (p = 0.027). The threshold with the highest sensitivity was 10% for Proclarix, 1.5% for the ERSPC MRI model, and 0.07 ng/ml/cm3 for PSAD, which yielded sensitivity of 100%, 91%, and 84%, respectively. Some 21.3%, 26.2%, and 7.1% of biopsies would be avoided with Proclarix, PSAD, and the ERSPC MRI model, respectively. Proclarix showed a net benefit over PSAD and the ERSPC MRI model. Both Proclarix and PSAD reduced iPCa overdetection from 16.6% to 11.3%, while the ERSPC MRI model reduced iPCa overdetection to 15.4%. Conclusions Proclarix was more accurate in selecting appropriate candidates for prostate biopsy among men in the PI-RADS 3 category when compared to PSAD and the ERSPC MRI model. Proclarix detected 100% of csPCa cases and would reduce prostate biopsies by 21.3% and iPCa overdetection by 5.3%. Patient summary We compared three methods and found that the Proclarix test can optimise the detection of clinically significant prostate cancer in men with a score of 3 on the Prostate Imaging-Reporting and Data System for magnetic resonance imaging scans.
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Affiliation(s)
- Juan Morote
- Department of Urology, Vall d’Hebron Hospital, Barcelona, Spain
- Prostate Cancer Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Radiology, Vall d’Hebron Hospital, Barcelona, Spain
- Corresponding author. Department of Urology, Vall d’Hebron Hospital, Passeig Vall d’Hebron, 119–129, 08035 Barcelona, Spain. Tel. +34 2746009.
| | - Miriam Campistol
- Prostate Cancer Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Marina Triquell
- Prostate Cancer Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Anna Celma
- Department of Urology, Vall d’Hebron Hospital, Barcelona, Spain
- Prostate Cancer Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Lucas Regis
- Department of Urology, Vall d’Hebron Hospital, Barcelona, Spain
- Prostate Cancer Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Inés de Torres
- Prostate Cancer Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Pathology, Vall d’Hebron Hospital, Barcelona, Spain
- Universitat Autònoma of Barcelona, Barcelona, Spain
| | - Maria E. Semidey
- Prostate Cancer Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Radiology, Vall d’Hebron Hospital, Barcelona, Spain
- Department of Pathology, Vall d’Hebron Hospital, Barcelona, Spain
| | - Richard Mast
- Department of Radiology, Vall d’Hebron Hospital, Barcelona, Spain
| | - Anna Santamaria
- Prostate Cancer Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Jacques Planas
- Department of Urology, Vall d’Hebron Hospital, Barcelona, Spain
- Prostate Cancer Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Enrique Trilla
- Department of Urology, Vall d’Hebron Hospital, Barcelona, Spain
- Universitat Autònoma of Barcelona, Barcelona, Spain
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Morote J, Campistol M, Regis L, Celma A, de Torres I, Semidey ME, Roche S, Mast R, Santamaria A, Planas J, Trilla E. Who with suspected prostate cancer can benefit from Proclarix after multiparametric magnetic resonance imaging? Int J Biol Markers 2022; 37:218-223. [PMID: 35200058 DOI: 10.1177/03936155221081537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Proclarix is a new blood-based test to assess the likelihood of clinically significant prostate cancer (csPCa) defined as >2 grade group. In this study, we analyzed whether Proclarix and PSA density (PSAD) could improve the selection of candidates for prostate biopsy after multiparametric magnetic resonance imaging (mpMRI). Proclarix and PSAD were assessed in 567 consecutive men with suspected PCa in whom pre-biopsy 3 Tesla mpMRI, scoring with Prostate Imaging-Report and Data System (PI-RADS) v.2, and guided and/or systematic biopsies were performed. Proclarix and PSAD thresholds having csPCa sensitivity over 90% were found at 10% and 0.07 ng/(mL*cm3), respectively. Among 100 men with negative mpMRI (PI-RADS <3), csPCa was detected in 6 cases, which would have been undetected if systematic biopsies were avoided. However, Proclarix suggested performing a biopsy on 70% of men with negative mpMRI. In contrast, PSAD only detected 50% of csPCa and required 71% of prostate biopsies. In 169 men with PI-RADS 3, Proclarix avoided 21.3% of prostate biopsies and detected all 25 cases of csPCa, while PSAD avoided 26.3% of biopsies, but missed 16% of csPCa. In 190 men with PI-RADS 4 and 108 with PI-RADS 5, Proclarix avoided 12.1% and 5.6% of prostate biopsies, but missed 4.8% and 1% of csPCa, respectively. PSAD avoided 18.4% and 9.3% of biopsies, but missed 11.4% and 4.2% csPCa, respectively. We conclude that Proclarix outperformed PSAD in the selection of candidates for prostate biopsy, especially in men with PI-RADS <3.
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Affiliation(s)
- Juan Morote
- Department of Urology, 16810Vall d´Hebron Hospital, Barcelona, Spain.,Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain.,Universitat Autònoma of Barcelona, Barcelona, Spain
| | - Miriam Campistol
- Department of Urology, 16810Vall d´Hebron Hospital, Barcelona, Spain
| | - Lucas Regis
- Department of Urology, 16810Vall d´Hebron Hospital, Barcelona, Spain.,Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Anna Celma
- Department of Urology, 16810Vall d´Hebron Hospital, Barcelona, Spain.,Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Inés de Torres
- Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain.,Universitat Autònoma of Barcelona, Barcelona, Spain.,Department of Pathology, 16810Vall d´Hebron Hospital, Barcelona, Spain
| | - Maria E Semidey
- Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain.,Universitat Autònoma of Barcelona, Barcelona, Spain.,Department of Pathology, 16810Vall d´Hebron Hospital, Barcelona, Spain
| | - Sarai Roche
- Department of Radiology, 16810Vall d´Hebron Hospital, Barcelona, Spain
| | - Richard Mast
- Department of Radiology, 16810Vall d´Hebron Hospital, Barcelona, Spain
| | - Anna Santamaria
- Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Jacques Planas
- Department of Urology, 16810Vall d´Hebron Hospital, Barcelona, Spain.,Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Enrique Trilla
- Department of Urology, 16810Vall d´Hebron Hospital, Barcelona, Spain.,Prostate Cancer Research Group, Vall d´Hebron Research Institute, Barcelona, Spain.,Universitat Autònoma of Barcelona, Barcelona, Spain
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Prediction of clinically significant prostate cancer after negative prostate biopsy: The current value of microscopic findings. Urol Oncol 2020; 39:432.e11-432.e19. [PMID: 33160846 DOI: 10.1016/j.urolonc.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/25/2020] [Accepted: 10/22/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the current ability of atypical small acinar proliferation (ASAP), multifocal high-grade prostatic intraepithelial neoplasia (mHGPIN), HGPIN with atypia (PINATYP) and other non-malignant lesions to predict clinically significant prostate cancer (csPCa) in repeat prostate biopsies. METHODS This retrospective study analyzed 377 repeat prostate biopsies, carried out between 2.014 and 2.017, and excluding those with previous PCa or 5-alpha reductase inhibitors treatment. ASAP, mHGPIN, PINATYP, prostatic atrophy, prostatic hyperplastic atrophy, proliferative inflammatory atrophy (PIA), chronic prostatitis, acute prostatitis, or granulomatous prostatitis, were prospectively reported after 12-core transrectal ultrasound (TRUS) systematic negative previous biopsies. 3T-multiparametric magnetic resonance imaging (mpMRI) was performed previous repeat biopsies. At least 2-core TRUS targeted biopsies of Prostate Imaging-Reporting and Data Systemv2 lesions ≥3, and/or 12-core TRUS systematic biopsy were performed in repeat prostate biopsies. The main outcome measurements were csPCa detection, which was defined when the International Society of Uro-Pathology group grade >1 and avoided biopsies. After logistic regression analysis the most efficient model was selected, nomogram was designed with internal validation, and clinical utility was analyzed. RESULTS Normal benign tissue alone was present in less than 2% of previous negative biopsies. mHGPIN (39.7%), ASAP (4.3%) and PINATYP (3.7%) failed to predict csPCa risk in repeat biopsies. The finding of PIA (38.2%) associated with a decreased the risk of csPCa with an Odd ratio of 0.54 (95% confidence interval: 0.31-0.95), P= 0.031. The area under the curve, to predict csPCa, of mpMRI was 0.736, increasing up to 0.860 (95% confidence internal:0.82-0.90) when PSA density, age, digital rectal examination, and differential PSA between biopsies and PIA finding were integrated in a predictive model. At 6% threshold, more than 20% of repeat prostate biopsies were saved without missing csPCa. CONCLUSION Currently, mHGPIN in negative prostate biopsy seems not able to predict the risk of future csPCa. The low incidence of ASAP and PINATYP, in our series, did not allow us to draw conclusions. PIA finding associated with a reduced risk of csPCa, and it could be integrated in a useful based-mpMRI predictive nomogram.
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