Imaging as a Personalized Biomarker for Prostate Cancer Risk Stratification

Abstract

Biomarkers provide objective data to guide clinicians in disease management. Prostate-specific antigen serves as a biomarker for screening of prostate cancer but has come under scrutiny for detection of clinically indolent disease. Multiple imaging techniques demonstrate promising results for diagnosing, staging, and determining definitive management of prostate cancer. One such modality, multiparametric magnetic resonance imaging (mpMRI), detects more clinically significant disease while missing lower volume and clinically insignificant disease. It also provides valuable information regarding tumor characteristics such as location and extraprostatic extension to guide surgical planning. Information from mpMRI may also help patients avoid unnecessary biopsies in the future. It can also be incorporated into targeted biopsies as well as following patients on active surveillance. Other novel techniques have also been developed to detect metastatic disease with advantages over traditional computer tomography and magnetic resonance imaging, which primarily rely on defined size criteria. These new techniques take advantage of underlying biological changes in prostate cancer tissue to identify metastatic disease. The purpose of this review is to present literature on imaging as a personalized biomarker for prostate cancer risk stratification.

Systematic versus Targeted Magnetic Resonance Imaging/Ultrasound Fusion Prostate Biopsy among Men with Visible Lesions

“…11 Imaging with mpMRI carries dual benefits by providing the risk stratification expected of a biomarker but also directly improving prostate sampling through targeted biopsies. 12 The evidence base for mpMRI continues to grow across the biopsy-na€ ıve, prior negative biopsy and active surveillance settings. 4e8, 13,14 In the present analysis, we confirm the benefits of targeted biopsy over systematic biopsy alone to detect more csPCa (D4.6%) and less GG1 PCa (À6.5%) in the largest cohort to date with PI-RADS graded mpMRI lesions excluding men with histologically diagnosed PCa.…”

“…11 Imaging with mpMRI carries dual benefits by providing the risk stratification expected of a biomarker but also directly improving prostate sampling through targeted biopsies. 12 The evidence base for mpMRI continues to grow across the biopsy-naïve, prior negative biopsy and active surveillance settings. 4–8,13,14…”

Pilot study of gadoxetate disodium-enhanced mri for localized and metastatic prostate cancers

“…The use of non-invasive imaging techniques to increase our understanding of prostate cancer development, progression and to aid physicians in risk stratification is a rapidly expanding field 13 . Gadoxetate disodium (Gadoxetic acid, Gd-EOB-DTPA; Eovist) is an FDA-approved gadolinium-based hepatoselective MRI contrast agent that has a proven role in improving the diagnosis and classification of liver lesions 14 , 15 .…”

Integrating risk calculators into routine clinical workflow for the detection of prostate cancer: next steps to achieve widespread adoption

“…With the addition of imaging with multiparametric MRI into the diagnostic landscape, we have found high-fidelity colocalization of imaging areas of suspicion and foci of clinically-significant prostate cancer with a less common diagnosis of low-grade, low-volume disease [3]. Due to its widespread use and high fidelity, the integration of MRI findings, as a functional biomarker of risk, is critical in the current and future generations of risk calculators used for prostate cancer detection [4]. Hence, risk calculators integrating MRI findings when available, can truly derive recommendations based on readily available, pre-biopsy datapoints to help guide shared decision-making in the prebiopsy setting, with the ultimate goals of minimizing the number and frequency of biopsies, without compromising the diagnosis of clinically-significant prostate cancers that would benefit from early diagnosis and curative treatment [5,6].…”