Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice

Pastor-Navarro, Belén; Rubio‐Briones, J.; Borque‐Fernando, Ángel; Esteban, Luis; Domínguez-Escrig, José; Löpez‐Guerrero, José Antonio

doi:10.3390/ijms22126266

Cited by 17 publications

(12 citation statements)

References 70 publications

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“…Accordingly, PHI appeared in the diagnostic algorithm for patients with suspected PCa both to select patients for MRI and biopsy [ 35 ]. In addition, PHI has been proposed as a tool to select and monitor patients on active surveillance (AS) [ 36 , 37 , 38 ], and the diagnostic accuracy of PHI for the identification of csPCa might be increased when combined with mpMRI. Several authors showed that the addition of PHI and PHI density to a multivariable model including PI-RADS v2 was able to predict biopsy reclassification with AUCs higher than 0.80 [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Prostate Health Index and Multiparametric MRI: Partners in Crime Fighting Overdiagnosis and Overtreatment in Prostate Cancer

Ferro

Crocetto

Bruzzese

et al. 2021

Cancers

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Widespread use of PSA as the standard tool for prostate cancer (PCa) diagnosis led to a high rate of overdiagnosis and overtreatment. In this study, we evaluated the performance of the prostate health index (PHI) and multiparametric magnetic resonance imaging (mpMRI) for the prediction of positive biopsy and of high-grade PCa at radical prostatectomy (RP). To this end, we prospectively enrolled 196 biopsy-naïve patients who underwent mpMRI. A subgroup of 116 subjects with biopsy-proven PCa underwent surgery. We found that PHI significantly outperformed both PI-RADS score (difference in AUC: 0.14; p < 0.001) and PHI density (difference in AUC: 0.08; p = 0.002) in the ability to predict positive biopsy with a cut-off value of 42.7 as the best threshold. Conversely, comparing the performance in the identification of clinically significant prostate cancer (csPCa) at RP, we found that PHI ≥61.68 and PI-RADS score ≥4 were able to identify csPCa (Gleason score ≥7 (3 + 4)) both alone and added to a base model including age, PSA, fPSA-to-tPSA ratio and prostate volume. In conclusion, PHI had a better ability than PI-RADS score to predict positive biopsy, whereas it had a comparable performance in the identification of pathological csPCa.

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Section: Discussionmentioning

confidence: 99%

Prostate Health Index and Multiparametric MRI: Partners in Crime Fighting Overdiagnosis and Overtreatment in Prostate Cancer

Ferro

Crocetto

Bruzzese

et al. 2021

Cancers

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“…PROGENSA PCA3 is the first FDA-approved urine-based molecular test that detects the overexpression of the PCA3 gene [66]. In conjunction with clinical information, this test could help in the decision to repeat a biopsy.…”

Section: Urine Biomarkersmentioning

confidence: 99%

Active Surveillance in Prostate Cancer: Current and Potentially Emerging Biomarkers for Patient Selection Criteria

et al. 2022

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Background: Prostate cancer (PCa) represents one of the most frequent malignancies and the fifth leading cause of cancer death in adult men worldwide. PCa mortality rates have been declining in several Western countries; one of the possible reasons may be related to the application of prostate-specific antigen early detection policies. These early detection protocols increase PCa-specific patient survival; however, a high percentage of these cases corresponds to low-risk PCa that grows very slowly and is unlikely to metastasize to threaten survival. Many low-risk PCa patients receive aggressive therapies, such as radical prostatectomy and radiotherapy, that are costly for patients and/or health systems and generate side effects that affect the quality of life. An alternative to surgery and radiotherapy treatments for low-risk PCa is active surveillance (AS), a strategy based on close disease monitoring and intervention only if the disease progresses. However, proper identification of low-risk PCa patients at the time of diagnosis is essential for the effectiveness AS. The selection of AS candidates remains challenging; thus, effective prognostic biomarkers are needed. Summary: This review article addresses the characteristics of the current and emerging PCa prognostic biomarkers, including tests available for tissue, blood, and urine analyses, for the appropriate selection of PCa patients for AS. In addition, and based on published literature, we performed a selection of potential new biomarkers that can distinguish low-risk PCa. Key Messages: The literature search yielded four tissue-based tests, two blood-based tests, and six urine-based tests that can be used to determine PCa risk classification. However, most available tests are expensive; thus, cost-effective analyses are needed in order to obtain the approval of government agencies and to be financed by the health systems. Available prognostic urine tests have shown great progress over the last years, and they have the advantage of being minimally invasive; therefore, they may become a routine disease progression test for patients under AS. In addition, new research conducted in the last decade has shown promising biomarkers, including mRNA, miRNA, long noncoding RNA, and metabolites, that could improve existing tests or allow the development of new tools for AS patient selection.

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“…Active surveillance is accepted as a management option for favorable-risk prostate cancer. However, due to the heterogeneity of this population, the lack of personalized risk assessments and the absence of treatment, the long-term outcome of active surveillance is not satisfying for approximately 30% of patients ( Dhawan et al, 2016 ; Moschini et al, 2017 ; Overland et al, 2019 ; Pastor-Navarro et al, 2021 ). Since active surveillance patients are diagnosed with either prostatic intraepithelial neoplasia (PIN) or early-stage cancer (Gleason <6), it is apparent that various carcinogenic signaling pathways are already activated and can lead to pathological or clinical progression.…”

Section: Introductionmentioning

confidence: 99%

Dietary stilbenes as modulators of specific miRNAs in prostate cancer

Levenson

2022

Front. Pharmacol.

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Accumulated experimental data have suggested that natural plant products may be effective miRNA-modulating chemopreventive and therapeutic agents. Dietary polyphenols such as flavonoids, stilbenes, and lignans, among others, have been intensively studied for their miRNA-mediated cardioprotective, antioxidant, anti-inflammatory and anticancer properties. The aim of this review is to outline known stilbene-regulated miRNAs in cancer, with a special focus on the interplay between various miRNAs and MTA1 signaling in prostate cancer. MTA1 is an epigenetic reader and an oncogenic transcription factor that is overexpressed in advanced prostate cancer and metastasis. Not surprisingly, miRNAs that are linked to MTA1 affect cancer progression and the metastatic potential of cells. Studies led to the identification of MTA1-associated pro-oncogenic miRNAs, which are regulated by stilbenes such as resveratrol and pterostilbene. Specifically, it has been shown that inhibition of the activity of the MTA1 regulated oncogenic miR-17 family of miRNAs, miR-22, and miR-34a by stilbenes leads to inhibition of prostatic hyperplasia and tumor progression in mice and reduction of proliferation, survival and invasion of prostate cancer cells in vitro. Taken together, these findings implicate the use of resveratrol and its analogs as an attractive miRNA-mediated chemopreventive and therapeutic strategy in prostate cancer and the use of circulating miRNAs as potential predictive biomarkers for clinical development.

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Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice

Cited by 17 publications

References 70 publications

Prostate Health Index and Multiparametric MRI: Partners in Crime Fighting Overdiagnosis and Overtreatment in Prostate Cancer

Prostate Health Index and Multiparametric MRI: Partners in Crime Fighting Overdiagnosis and Overtreatment in Prostate Cancer

Active Surveillance in Prostate Cancer: Current and Potentially Emerging Biomarkers for Patient Selection Criteria

Dietary stilbenes as modulators of specific miRNAs in prostate cancer

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