1
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Hougen HY, Reis IM, Han S, Prakash NS, Thomas J, Stoyanova R, Castillo RP, Kryvenko ON, Ritch CR, Nahar B, Gonzalgo ML, Gaston SM, Abramowitz MC, Dal Pra A, Mahal BA, Pollack A, Parekh DJ, Punnen S. Evaluating 4Kscore's role in predicting progression on active surveillance for prostate cancer independently of clinical information and PIRADS score. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00898-w. [PMID: 39333697 DOI: 10.1038/s41391-024-00898-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/21/2024] [Accepted: 09/17/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND 4Kscore is used to aid the decision for prostate biopsy, however its role in active surveillance (AS) has not been investigated in a magnetic resonance imaging (MRI)-based protocol. Our objective was to assess the association between 4Kscore and progression in men undergoing AS on a prospective MRI-based protocol. METHODS This was a single-institution, single-arm, non-therapeutic, interventional trial of 166 men with biopsy-confirmed prostate cancer enrolled between 2014-2020. Patients were placed on a trial-mandated AS protocol including yearly multiparametric (mp)MRI, prostate biopsy, and 4Kscore followed for 48 months after diagnosis. We analyzed protocol-defined and grade progression at confirmatory and subsequent surveillance biopsies. RESULTS Out of 166 patients, 83 (50%) men progressed per protocol and of them 41 (24.7% of whole cohort) progressed by grade. At confirmatory biopsy, men with a baseline 4Kscore ≥ 20% had a higher risk of grade progression compared to those with 4Kscore < 20% (OR = 4.04, 95% CI: 1.05-15.59, p = 0.043) after adjusting for National Comprehensive Cancer Network (NCCN) risk and baseline PIRADS score. At surveillance biopsies, most recent 4Kscore ≥ 20% significantly predicted per protocol (OR = 2.61, 95% CI: 1.03-6.63, p = 0.044) and grade progression (OR = 5.13, 95% CI: 1.63-16.11, p = 0.005). CONCLUSIONS For patients on AS, baseline 4Kscore predicted grade progression at confirmatory biopsy, and most recent 4Kscore predicted per-protocol and grade progression at surveillance biopsy.
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Affiliation(s)
- Helen Y Hougen
- University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA, USA.
| | - Isildinha M Reis
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Biostatistics and Bioinformatics Shared Resources, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sunwoo Han
- Biostatistics and Bioinformatics Shared Resources, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jamie Thomas
- Desai Sethi Urology Institute, University of Miami, Miami, FL, USA
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - R Patricia Castillo
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Oleksandr N Kryvenko
- Desai Sethi Urology Institute, University of Miami, Miami, FL, USA
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad R Ritch
- Desai Sethi Urology Institute, University of Miami, Miami, FL, USA
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami, Miami, FL, USA
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami, Miami, FL, USA
| | - Sandra M Gaston
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Matthew C Abramowitz
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Desai Sethi Urology Institute, University of Miami, Miami, FL, USA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami, Miami, FL, USA
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2
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Shah P, Taylor WR, Negaard BJ, Gochanour BR, Mahoney DW, Then SS, Devens ME, Foote PH, Doering KA, Burger KN, Nikolai B, Kaiser MW, Allawi HT, Cheville JC, Kisiel JB, Gettman MT. Methylated DNA Markers in Voided Urine for the Identification of Clinically Significant Prostate Cancer. Life (Basel) 2024; 14:1024. [PMID: 39202766 PMCID: PMC11355912 DOI: 10.3390/life14081024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
INTRODUCTION Non-invasive assays are needed to better discriminate patients with prostate cancer (PCa) to avoid over-treatment of indolent disease. We analyzed 14 methylated DNA markers (MDMs) from urine samples of patients with biopsy-proven PCa relative to healthy controls and further studied discrimination of clinically significant PCa (csPCa) from healthy controls and Gleason 6 cancers. METHODS To evaluate the panel, urine from 24 healthy male volunteers with no clinical suspicion for PCa and 24 men with biopsy-confirmed disease across all Gleason scores was collected. Blinded to clinical status, DNA from the supernatant was analyzed for methylation signal within specific DNA sequences across 14 genes (HES5, ZNF655, ITPRIPL1, MAX.chr3.6187, SLCO3A1, CHST11, SERPINB9, WNT3A, KCNB2, GAS6, AKR1B1, MAX.chr3.8028, GRASP, ST6GALNAC2) by target enrichment long-probe quantitative-amplified signal assays. RESULTS Utilizing an overall specificity cut-off of 100% for discriminating normal controls from PCa cases across the MDM panel resulted in 71% sensitivity (95% CI: 49-87%) for PCa detection (4/7 Gleason 6, 8/12 Gleason 7, 5/5 Gleason 8+) and 76% (50-92%) for csPCa (Gleason ≥ 7). At 100% specificity for controls and Gleason 6 patients combined, MDM panel sensitivity was 59% (33-81%) for csPCa (5/12 Gleason 7, 5/5 Gleason 8+). CONCLUSIONS MDMs assayed in urine offer high sensitivity and specificity for detection of clinically significant prostate cancer. Prospective evaluation is necessary to estimate discrimination of patients as first-line screening and as an adjunct to prostate-specific antigen (PSA) testing.
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Affiliation(s)
- Paras Shah
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA;
| | - William R. Taylor
- Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA; (W.R.T.); (B.J.N.); (S.S.T.); (M.E.D.); (P.H.F.); (K.A.D.); (J.B.K.)
| | - Brianna J. Negaard
- Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA; (W.R.T.); (B.J.N.); (S.S.T.); (M.E.D.); (P.H.F.); (K.A.D.); (J.B.K.)
| | - Benjamin R. Gochanour
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN 55905, USA; (B.R.G.); (D.W.M.); (K.N.B.)
| | - Douglas W. Mahoney
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN 55905, USA; (B.R.G.); (D.W.M.); (K.N.B.)
| | - Sara S. Then
- Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA; (W.R.T.); (B.J.N.); (S.S.T.); (M.E.D.); (P.H.F.); (K.A.D.); (J.B.K.)
| | - Mary E. Devens
- Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA; (W.R.T.); (B.J.N.); (S.S.T.); (M.E.D.); (P.H.F.); (K.A.D.); (J.B.K.)
| | - Patrick H. Foote
- Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA; (W.R.T.); (B.J.N.); (S.S.T.); (M.E.D.); (P.H.F.); (K.A.D.); (J.B.K.)
| | - Karen A. Doering
- Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA; (W.R.T.); (B.J.N.); (S.S.T.); (M.E.D.); (P.H.F.); (K.A.D.); (J.B.K.)
| | - Kelli N. Burger
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN 55905, USA; (B.R.G.); (D.W.M.); (K.N.B.)
| | - Brandon Nikolai
- Exact Sciences Corporation, Madison, WI 53719, USA; (B.N.); (M.W.K.); (H.T.A.)
| | - Michael W. Kaiser
- Exact Sciences Corporation, Madison, WI 53719, USA; (B.N.); (M.W.K.); (H.T.A.)
| | - Hatim T. Allawi
- Exact Sciences Corporation, Madison, WI 53719, USA; (B.N.); (M.W.K.); (H.T.A.)
| | - John C. Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA;
| | - John B. Kisiel
- Division of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA; (W.R.T.); (B.J.N.); (S.S.T.); (M.E.D.); (P.H.F.); (K.A.D.); (J.B.K.)
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Gallo G, Lombardo R, De Nunzio C. Re: Hein V. Stroomberg, Signe Benzon Larsen, Torben Kjær Nielsen, J. Thomas Helgstrand, Klaus Brasso, Andreas Røder. Outcomes of Biopsy Grade Group 1 Prostate Cancer Diagnosis in the Danish Population. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2023.10.005. Eur Urol Oncol 2024; 7:646-647. [PMID: 38290922 DOI: 10.1016/j.euo.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Giacomo Gallo
- Department of Urology, Sapienza University of Rome, Rome, Italy.
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Liu Y, Hatano K, Nonomura N. Liquid Biomarkers in Prostate Cancer Diagnosis: Current Status and Emerging Prospects. World J Mens Health 2024; 42:42.e45. [PMID: 38772530 DOI: 10.5534/wjmh.230386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 05/23/2024] Open
Abstract
Prostate cancer (PCa) is a major health concern that necessitates appropriate diagnostic approaches for timely intervention. This review critically evaluates the role of liquid biopsy techniques, focusing on blood- and urine-based biomarkers, in overcoming the limitations of conventional diagnostic methods. The 4Kscore test and Prostate Health Index have demonstrated efficacy in distinguishing PCa from benign conditions. Urinary biomarker tests such as PCa antigen 3, MyProstateScore, SelectMDx, and ExoDx Prostate IntelliScore test have revolutionized risk stratification and minimized unnecessary biopsies. Emerging biomarkers, including non-coding RNAs, circulating tumor DNA, and prostate-specific antigen (PSA) glycosylation, offer valuable insights into PCa biology, enabling personalized treatment strategies. Advancements in non-invasive liquid biomarkers for PCa diagnosis may facilitate the stratification of patients and avoid unnecessary biopsies, particularly when PSA is in the gray area of 4 to 10 ng/mL.
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Affiliation(s)
- Yutong Liu
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koji Hatano
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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5
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A Novel Blood Proteomic Signature for Prostate Cancer. Cancers (Basel) 2023; 15:cancers15041051. [PMID: 36831393 PMCID: PMC9954127 DOI: 10.3390/cancers15041051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Prostate cancer is the most common malignant tumour in men. Improved testing for diagnosis, risk prediction, and response to treatment would improve care. Here, we identified a proteomic signature of prostate cancer in peripheral blood using data-independent acquisition mass spectrometry combined with machine learning. A highly predictive signature was derived, which was associated with relevant pathways, including the coagulation, complement, and clotting cascades, as well as plasma lipoprotein particle remodeling. We further validated the identified biomarkers against a second cohort, identifying a panel of five key markers (GP5, SERPINA5, ECM1, IGHG1, and THBS1) which retained most of the diagnostic power of the overall dataset, achieving an AUC of 0.91. Taken together, this study provides a proteomic signature complementary to PSA for the diagnosis of patients with localised prostate cancer, with the further potential for assessing risk of future development of prostate cancer. Data are available via ProteomeXchange with identifier PXD025484.
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6
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Rasmussen M, Fredsøe J, Tin AL, Vickers AJ, Ulhøi B, Borre M, Eastham J, Ehdaie B, Guillonneau B, Laudone V, Scardino PT, Touijer K, Sørensen KD, Lilja H. Independent validation of a pre-specified four-kallikrein marker model for prediction of adverse pathology and biochemical recurrence. Br J Cancer 2022; 126:1004-1009. [PMID: 34903844 PMCID: PMC8980060 DOI: 10.1038/s41416-021-01661-x] [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: 06/17/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Accurate markers for prostate cancer (PC) risk stratification could aid decision-making for initial management strategies. The 4Kscore has an undefined role in predicting outcomes after radical prostatectomy (RP). METHODS We included 1476 patients with 4Kscore measured prior to RP at two institutions. The 4Kscore was assessed for prediction of adverse pathology at RP and biochemical recurrence (BCR) relative to a clinical model. We pre-specified that all analyses would be assessed in biopsy Grade Group 1 (GG1) or 2 (GG2) PC patients, separately. RESULTS The 4Kscore increased discrimination for adverse pathology in all patients (delta area under the receiver operative curve (AUC) 0.009, 95% confidence interval (CI) 0.002, 0.016; clinical model AUC 0.767), driven by GG1 (delta AUC 0.040, 95% CI 0.006, 0.073) rather than GG2 patients (delta AUC 0.005, 95% CI -0.012, 0.021). Adding 4Kscore improved prediction of BCR in all patients (delta C-index 0.014, 95% CI 0.007, 0.021; preop-BCR nomogram C-index 0.738), again with larger changes in GG1 than in GG2. CONCLUSIONS This study validates prior investigations on the use of 4Kscore in men with biopsy-confirmed PC. Men with GG1 PC and a high 4Kscore may benefit from additional testing to guide treatment selection. Further research is warranted regarding the value of the 4Kscore in men with biopsy GG2 PC.
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Affiliation(s)
- Martin Rasmussen
- grid.154185.c0000 0004 0512 597XDepartment of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jacob Fredsøe
- grid.154185.c0000 0004 0512 597XDepartment of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Amy L. Tin
- grid.51462.340000 0001 2171 9952Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Andrew J. Vickers
- grid.51462.340000 0001 2171 9952Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Benedicte Ulhøi
- grid.154185.c0000 0004 0512 597XDepartment of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - James Eastham
- grid.51462.340000 0001 2171 9952Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Behfar Ehdaie
- grid.51462.340000 0001 2171 9952Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Bertrand Guillonneau
- grid.51462.340000 0001 2171 9952Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY USA ,grid.6363.00000 0001 2218 4662Uro-Oncology Department, Charité University Hospital, Berlin, Germany
| | - Vincent Laudone
- grid.51462.340000 0001 2171 9952Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Peter T. Scardino
- grid.51462.340000 0001 2171 9952Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Karim Touijer
- grid.51462.340000 0001 2171 9952Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Karina D. Sørensen
- grid.154185.c0000 0004 0512 597XDepartment of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hans Lilja
- grid.51462.340000 0001 2171 9952Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA ,grid.4514.40000 0001 0930 2361Department of Translational Medicine, Lund University, Malmö, Sweden
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7
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Fiorella D, Marenco JL, Mascarós JM, Borque-Fernando Á, Esteban LM, Calatrava A, Pastor B, López-Guerrero JA, Rubio-Briones J. Role of PCA3 and SelectMDx in the optimization of active surveillance in prostate cancer. Actas Urol Esp 2021; 45:439-446. [PMID: 34148844 DOI: 10.1016/j.acuroe.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION & OBJECTIVES A not negligible percentage of patients included in active surveillance (AS) for low and very low risk prostate cancer (PCa) are reclassified in the confirmatory biopsy or have disease progression during follow-up. Our aim is to evaluate the role of PCA3 and SelectMDx, in an individual and combined way, in the prediction of pathological progression (PP) in a standard AS program. MATERIALS & METHODS Prospective and observational study comprised of 86 patients enrolled in an AS program from 2009 to 2019, with results for PCA3 and SelectMDx previous to PCa diagnosis or during their confirmatory period. Univariate and multivariate analysis were performed to correlate PCA3 and SelectMDx scores as well as clinical and pathological variables with PP-free survival (PPFS). The most reliable cut-offs for both biomarkers in the context of AS were defined. RESULTS SelectMDx showed statistically significant differences related to PPFS (HR 1.035, 95%CI: 1.012-1.057) (p = 0.002) with a C-index of 0.670 (95%CI: 0.529-0.810) and AUC of 0.714 (95%CI: 0.603-0.825) at 5 years. In our series, the most reliable cut-off point for SelectMDx was 5, with a sensitivity and specificity for PP of 69.8% and 67.4%, respectively. Same figure for PCA3 was 65, with a sensitivity and specificity for PP of 51.16% and 74.42%, respectively. The combination of both biomarkers did not improve the prediction of PP, C-index 0.630 (95%CI: 0.455-0.805). CONCLUSIONS In the context of low or very low risk PCa, SelectMDx > 5 predicted 5 years PP free survival with a moderate discrimination ability outperforming PCA3. The combination of both tests did not improved outcomes.
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Affiliation(s)
- D Fiorella
- Departamento de Urología, Instituto Valenciano de Oncología, Valencia, Spain
| | - J L Marenco
- Departamento de Urología, Instituto Valenciano de Oncología, Valencia, Spain
| | - J M Mascarós
- Departamento de Urología, Instituto Valenciano de Oncología, Valencia, Spain
| | - Á Borque-Fernando
- Departamento de Urología, IIS-Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - L M Esteban
- Departamento de Matemáticas Aplicadas, Escuela Universitaria Politécnica de La Almunia, Universidad de Zaragoza, La Almuniade Doña Godina, Zaragoza, Spain
| | - A Calatrava
- Departamento de Patología, Instituto Valenciano de Oncología, Valencia, Spain
| | - B Pastor
- Laboratorio de Biología Molecular, Instituto Valenciano de Oncología, Valencia, Spain
| | - J A López-Guerrero
- Laboratorio de Biología Molecular, Instituto Valenciano de Oncología, Valencia, Spain; IVO-CIPF Joint Research Unit of Cancer, Centro de Investigación Príncipe Felipe (CIPF), Valencia, Spain; Departamento de Patología, Facultad de Medicina, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - J Rubio-Briones
- Departamento de Urología, Instituto Valenciano de Oncología, Valencia, Spain.
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8
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Pastor-Navarro B, Rubio-Briones J, Borque-Fernando Á, Esteban LM, Dominguez-Escrig JL, López-Guerrero JA. Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice. Int J Mol Sci 2021; 22:6266. [PMID: 34200878 PMCID: PMC8230496 DOI: 10.3390/ijms22126266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/03/2021] [Accepted: 06/08/2021] [Indexed: 12/21/2022] Open
Abstract
Prostate cancer (PCa) is the most commonly diagnosed cancer in men. The diagnosis is currently based on PSA levels, which are associated with overdiagnosis and overtreatment. Moreover, most PCas are localized tumours; hence, many patients with low-/very low-risk PCa could benefit from active surveillance (AS) programs instead of more aggressive, active treatments. Heterogeneity within inclusion criteria and follow-up strategies are the main controversial issues that AS presently faces. Many biomarkers are currently under investigation in this setting; however, none has yet demonstrated enough diagnostic ability as an independent predictor of pathological or clinical progression. This work aims to review the currently available literature on tissue, blood and urine biomarkers validated in clinical practice for the management of AS patients.
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Affiliation(s)
- Belén Pastor-Navarro
- Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain;
- Príncipe Felipe Research Center (CIPF), IVO-CIPF Joint Research Unit of Cancer, 46012 Valencia, Spain
| | - José Rubio-Briones
- Department of Urology, Fundación Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain; (J.R.-B.); (J.L.D.-E.)
| | - Ángel Borque-Fernando
- Department of Urology, University Hospital Miguel Servet, IIS-Aragón, 50009 Zaragoza, Spain;
| | - Luis M. Esteban
- Department of Applied Mathematics, Engineering School of La Almunia, University of Zaragoza, 50100 Zaragoza, Spain;
| | - Jose Luis Dominguez-Escrig
- Department of Urology, Fundación Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain; (J.R.-B.); (J.L.D.-E.)
| | - José Antonio López-Guerrero
- Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain;
- Príncipe Felipe Research Center (CIPF), IVO-CIPF Joint Research Unit of Cancer, 46012 Valencia, Spain
- Department of Pathology, School of Medicine, Catholic University of Valencia ‘San Vicente Martir’, 46001 Valencia, Spain
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9
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Fiorella D, Marenco J, Mascarós J, Borque-Fernando A, Esteban L, Calatrava A, Pastor B, López-Guerrero J, Rubio-Briones J. Role of PCA3 and SelectMDx in the optimization of active surveillance in prostate cancer. Actas Urol Esp 2021. [PMID: 33926745 DOI: 10.1016/j.acuro.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES A not negligible percentage of patients included in active surveillance (AS) for low and very low risk prostate cancer (PCa) are reclassified in the confirmatory biopsy or have disease progression during follow-up. Our aim is to evaluate the role of PCA3 and SelectMDx, in an individual and combined way, in the prediction of pathological progression (PP) in a standard AS program. MATERIALS AND METHODS Prospective and observational study comprised of 86 patients enrolled in an AS program from 2009 to 2019, with results for PCA3 and SelectMDx previous to PCa diagnosis or during their confirmatory period. Univariate and multivariate analysis were performed to correlate PCA3 and SelectMDx scores as well as clinical and pathological variables with PP-free survival (PPFS). The most reliable cut-offs for both biomarkers in the context of AS were defined. RESULTS SelectMDx showed statistically significant differences related to PPFS (HR: 1.035; 95%CI: 1.012-1.057) (P=.002) with a C-index of 0.670 (95%CI: 0.529-0.810) and AUC of 0.714 (95%CI: 0.603-0.825) at 5years. In our series, the most reliable cut-off point for SelectMDx was 5, with a sensitivity and specificity for PP of 69.8% and 67.4%, respectively. Same figure for PCA3 was 65, with a sensitivity and specificity for PP of 51.16% and 74.42%, respectively. The combination of both biomarkers did not improve the prediction of PP, C-index 0.630 (95%CI: 0.455-0.805). CONCLUSIONS In the context of low or very low risk PCa, SelectMDx >5 predicted 5years PP free survival with a moderate discrimination ability outperforming PCA3. The combination of both tests did not improved outcomes.
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10
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Rubio-Briones J, Pastor Navarro B, Esteban Escaño LM, Borque Fernando A. Update and optimization of active surveillance in prostate cancer in 2021. Actas Urol Esp 2021; 45:1-7. [PMID: 33070989 DOI: 10.1016/j.acuro.2020.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/06/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Within the paradigm shift of the last decade in the management of prostate cancer (PCa), perhaps the most relevant event has been the emergence of active surveillance (AS) as a mandatory strategy in low-risk disease. We carry out a critical review of the clinical, pathological and radiological improvements that allow optimizing AS in 2021. MATERIAL AND METHODS Critical narrative review of the literature on improvement issues and controversial aspects of AS. RESULTS Adequate use of traditional criteria, optimized by enhanced biopsy and calculation of the prostate volume technique thanks to multiparametric magnetic resonance imaging (mpMRI) allow a better selection of patients for AS. This management should not be limited to patients under 60years of age, and patients with intermediate-risk PCa should be carefully selected to be included. Biopsies are still required in the follow-up, which can be personalized according to risk patterns. The pathologist must identify the cribriform or intraductal histology on biopsies in order to exclude these patients from AS, in the same way as with patients with alterations in DNA repair genes. CONCLUSIONS Controversial indications such as the inclusion of patients from intermediate-risk groups, or the transition to active treatment due to exclusive progression in tumor volume, should be further optimized. It is possible that the future competition of tissue biomarkers, the refinement of objective parameters of mpMRI and the validation of PSA kinetics calculators may sub-stratify risk groups.
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Affiliation(s)
- J Rubio-Briones
- Servicio de Urología, Instituto Valenciano de Oncología, Valencia, España.
| | - B Pastor Navarro
- Laboratorio de Biología Molecular, Instituto Valenciano de Oncología, Valencia, España
| | | | - A Borque Fernando
- Servicio Urología, Hospital Universitario Miguel Servet, Zaragoza, España
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11
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Salguero J, Gómez-Gómez E, Valero-Rosa J, Carrasco-Valiente J, Mesa J, Martin C, Campos-Hernández JP, Rubio JM, López D, Requena MJ. Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance. Korean J Radiol 2020; 22:559-567. [PMID: 33289358 PMCID: PMC8005352 DOI: 10.3348/kjr.2020.0852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023] Open
Abstract
Objective To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). Materials and Methods This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imaging-reporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. Results The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. Conclusion Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.
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Affiliation(s)
- Joseba Salguero
- Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University, Córdoba, Spain.
| | - Enrique Gómez-Gómez
- Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University, Córdoba, Spain
| | - José Valero-Rosa
- Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University, Córdoba, Spain
| | - Julia Carrasco-Valiente
- Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University, Córdoba, Spain
| | - Juan Mesa
- Department of Radiology, Reina Sofía University Hospital, IMIBIC, Cordoba University, Córdoba, Spain
| | - Cristina Martin
- Department of Radiology, Reina Sofía University Hospital, IMIBIC, Cordoba University, Córdoba, Spain
| | | | - Juan Manuel Rubio
- Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University, Córdoba, Spain
| | - Daniel López
- Department of Radiology, Reina Sofía University Hospital, IMIBIC, Cordoba University, Córdoba, Spain
| | - María José Requena
- Department of Urology, Reina Sofía University Hospital, IMIBIC, Cordoba University, Córdoba, Spain
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12
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Haese A, Tin AL, Carlsson SV, Sjoberg DD, Pehrke D, Steuber T, Huland H, Graefen M, Scardino PT, Schlomm T, Vickers AJ, Lilja H, Sauter G. A pre-specified model based on four kallikrein markers in blood improves predictions of adverse pathology and biochemical recurrence after radical prostatectomy. Br J Cancer 2020; 123:604-609. [PMID: 32467601 PMCID: PMC7434907 DOI: 10.1038/s41416-020-0914-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/17/2020] [Accepted: 05/06/2020] [Indexed: 01/01/2023] Open
Abstract
Background A pre-specified model based on four kallikrein markers in blood, commercially available as 4Kscore, predicts Gleason Grade (GG) 3 + 4 or higher prostate cancer on biopsy. However, sampling error and variation in pathology reporting may miss aggressive disease. Methods The 4Kscore was measured in cryopreserved blood from 2330 men obtained before prostatectomy at a single institution between 2002 and 2010. Adverse surgical pathology and biochemical recurrence (BCR) were pre-specified to be assessed in all men, biopsy GG 3 + 3, and 3 + 4. Results Adjusted for established clinical predictors, the 4Kscore was significantly associated with adverse pathology (OR 1.49; 95% CI 1.32, 1.67; p < 0.0001). Adding 4Kscore increased discrimination from (AUC) 0.672 to 0.718 and 0.644 to 0.659 within biopsy GG 3 + 3 and 3 + 4, respectively. Higher 4Kscore was associated with higher risk of BCR (HR 1.16, 95% CI 1.06, 1.26; p = 0.001). Adding 4Kscore improved the prediction of BCR (C-index 0.630–0.660) within GG 3 + 3, but not GG 3 + 4. Conclusions The 4Kscore can help guide the clinical decision whether additional risk assessment—such as confirmatory biopsy—is needed to decide between active surveillance versus curative therapy. Evidence that the panel could influence management in biopsy GG 3 + 4 is less strong and requires further investigation.
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Affiliation(s)
- Alexander Haese
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sigrid V Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dirk Pehrke
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter T Scardino
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thorsten Schlomm
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans Lilja
- Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Departments of Laboratory Medicine and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. .,Department of Translational Medicine, Lund University, Malmö, Sweden.
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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13
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Abstract
Prostate cancer remains among the most commonly diagnosed malignancies worldwide in men. In patients with low-risk prostate cancer, the risk of metastasis and mortality is very low; therefore, a tumor surveillance strategy can be used. In patients undergoing active surveillance, curative active therapy is postponed without compromising opportunities for cure until there is evidence of progression or the patient desires active therapy. The aim of active surveillance in prostate cancer patients is to minimize treatment-related toxicity without impairing patient survival. To maintain patients under active surveillance, the following criteria should be met: prostate-specific antigen (PSA) ≤10 ng/ml, Gleason score ≤6, cT1 or cT2a, ≤2 biopsy cores with <50% cancer involvement of every positive core. Follow-up in active surveillance patients is based on repeat biopsy, serial PSA measurements, and digital rectal examination.
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Affiliation(s)
- E Erne
- Klinik für Urologie, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - S Kaufmann
- Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - K Nikolaou
- Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - A Stenzl
- Klinik für Urologie, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - J Bedke
- Klinik für Urologie, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
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14
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Cantiello F, Russo GI, Kaufmann S, Cacciamani G, Crocerossa F, Ferro M, De Cobelli O, Artibani W, Cimino S, Morgia G, Damiano R, Nikolaou K, Kröger N, Stenzl A, Bedke J, Kruck S. Role of multiparametric magnetic resonance imaging for patients under active surveillance for prostate cancer: a systematic review with diagnostic meta-analysis. Prostate Cancer Prostatic Dis 2018; 22:206-220. [PMID: 30487646 DOI: 10.1038/s41391-018-0113-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/23/2018] [Accepted: 11/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The use of multiparametric magnetic resonance imaging (mpMRI) in the setting of patients under active surveillance (AS) is promising. In this systematic-review we aimed to analyse the role of mpMRI in patients under AS. METHODS A comprehensive literature research for English-language original and review articles, recently published, was carried out using Medline, Scopus and Web of sciences databases until 30 October 2017. The following MeSH terms were used: 'active surveillance', 'prostate cancer', 'multiparametric magnetic resonance imaging'. A diagnostic meta-analysis was performed for 3.0 T mpMRI in predicting disease re-classification. RESULTS In total, 226 studies were selected after research and after removal of duplicates. After analysis on inclusion criteria, 43 studies were identified as eligible for this systematic review with a total of 6,605 patients. The timing of MRI during follow-up of AS differed from all studies like criteria for inclusion in the AS protocol. Overall, there was a low risk of bias across all studies. The diagnostic meta-analysis for 1.5 tesla showed a sensitivity of 0.60, negative predictive value (NPV) of 0.75 and a hierarchical summary receiving operating curve (HSROC) of 0.74 while for 3.0 tesla mpMRI a sensitivity of 0.81, a NPV of 0.78 and a HSROC of 0.83. CONCLUSIONS Overall, the available evidence suggests that both 1.5 or 3.0 Tesla mpMRI are a valid tool to monitor progression during AS follow-up, showing good accuracy capabilities in detecting PCa re-classification. However, the modality to better define what means 'disease progression' on mpMRI must be further evaluated.
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Affiliation(s)
- Francesco Cantiello
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy.
| | - Sascha Kaufmann
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | | | - Fabio Crocerossa
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | | | - Walter Artibani
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Sebastiano Cimino
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Giuseppe Morgia
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Rocco Damiano
- Department of Urology, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Konstantin Nikolaou
- Department of Urology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Nils Kröger
- Department of Urology, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Arnulf Stenzl
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Jens Bedke
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Stephan Kruck
- Diagnostic and Interventional Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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15
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Mavrikou S, Moschopoulou G, Zafeirakis A, Kalogeropoulou K, Giannakos G, Skevis A, Kintzios S. An Ultra-Rapid Biosensory Point-of-Care (POC) Assay for Prostate-Specific Antigen (PSA) Detection in Human Serum. SENSORS 2018; 18:s18113834. [PMID: 30413115 PMCID: PMC6264089 DOI: 10.3390/s18113834] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 12/16/2022]
Abstract
Prostate-specific antigen (PSA) is the established routine screening tool for the detection of early-stage prostate cancer. Given the laboratory-centric nature of the process, the development of a portable, ultra rapid high-throughput system for PSA screening is highly desirable. In this study, an advancedpoint-of-care system for PSA detection in human serum was developed based on a cellular biosensor where the cell membrane was modified by electroinserting a specific antibody against PSA. Thirty nine human serum samples were used for validation of this biosensory system for PSA detection. Samples were analyzed in parallel with a standard immunoradiometric assay (IRMA) and an established electrochemical immunoassay was used for comparison purposes. They were classified in three different PSA concentration ranges (0, <4 and ≥4 ng/mL). Cells membrane-engineered with 0.25 μg/mL anti-PSA antibody demonstrated a statistically lower response against the upper (≥4 ng/mL) PSA concentration range. In addition, the cell-based biosensor performed better than the immunosensor in terms of sensitivity and resolution against positive samples containing <4 ng/mL PSA. In spite of its preliminary, proof-of-concept stage of development, the cell-based biosensor could be used as aninitiative for the development of a fast, low-cost, and high-throughput POC screening system for PSA.
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Affiliation(s)
- Sophie Mavrikou
- Laboratory of Cell Technology, Faculty of Biotechnology, Agricultural University of Athens, Iera Odos 75, 11855Athens, Greece.
| | - Georgia Moschopoulou
- Laboratory of Cell Technology, Faculty of Biotechnology, Agricultural University of Athens, Iera Odos 75, 11855Athens, Greece.
| | | | | | - Georgios Giannakos
- Army Share Fund Hospital of Athens, Monis Petraki 10, 11521 Athens, Greece.
| | - Athanasios Skevis
- Laboratory of Cell Technology, Faculty of Biotechnology, Agricultural University of Athens, Iera Odos 75, 11855Athens, Greece.
| | - Spyridon Kintzios
- Laboratory of Cell Technology, Faculty of Biotechnology, Agricultural University of Athens, Iera Odos 75, 11855Athens, Greece.
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