Improving the evaluation and diagnosis of clinically significant prostate cancer in 2017

Abstract

Purpose of review To provide an overview of the current state of the evidence and highlight recent advances in the evaluation and diagnosis of clinically significant prostate cancer, focusing on biomarkers, risk calculators and mpMRI. Recent findings In 2017, there are numerous options to improve early detection as compared to a purely PSA-based approach. All have strengths and drawbacks. In addition to repeating the PSA and performing clinical work-up (DRE and estimation of prostate volume), additional tests investigated in the initial biopsy setting are: %free PSA, PHI, 4Kscore, SelectMDx and MiPS and in the repeat setting: %free PSA, PHI, 4Kscore, PCA3, and ConfirmMDx. Risk calculators are available for both biopsy settings and incorporate clinical data with, or without, biomarkers. mpMRI is an important diagnostic adjunct. Summary There are numerous tests available that can help increase the specificity of PSA, in the initial and repeat biopsy setting. All coincide with a small decrease in sensitivity of detecting high-grade cancer. Cost effectiveness is crucial. The way forward is a multivariable risk assessment on the basis of readily available clinical data, potentially with the addition of PSA subforms, preferably at low cost. MRI in the pre-diagnostic setting is promising, but is not ready for “prime time”.

Seminal citrate is superior to PSA for detecting clinically significant prostate cancer

“…Cost effectiveness is crucial. The way forward is a multivariable risk assessment on the basis of readily available clinical data, potentially with the addition of PSA subforms, preferably at low cost (20).…”

Development of Prostate Cancer Organoid Culture Models in Basic Medicine and Translational Research

“…It is apart from hereditary cases with a peak incidence in aged men (75 years~) and the epidemiology remains unclear [2]. Human PC mainly exhibits low grade with slow progression [3] and can be easily diagnosed by measuring the plasma concentration of prostate-specific antigen (PSA) protein [4]. Although the overall death rate due to PC is gradually decreasing due to the improvements in early diagnosis and prevention, the late diagnosis of PC leads to advanced and metastatic disease in which the survival of patients shortens.…”

Prostate Health Index (PHI) improves prostate cancer detection at initial biopsy in Taiwanese men with PSA 4–10 ng/mL

“…Free PSA, Prostate Health Index (PHI), 4‐kallikrein score, Prostate Cancer Antigen 3 (PCA3), SelectMDx, and Michigan Prostate Score have been shown to improve the early detection of PCa [14], among which PHI is a cost‐effective one and was approved by the FDA in 2012. p2PSA is a truncated form of proPSA which contains two pro‐leader amino acids [15]. Its derivatives, %p2PSA and PHI, have been shown to improve the prediction of outcomes of prostate biopsies and define cancer aggressiveness [15–18].…”