Optimizing patient's selection for prostate biopsy: A single institution experience with multi-parametric MRI and the 4Kscore test for the detection of aggressive prostate cancer

Punnen, Sanoj; Nahar, Bruno; Soodana‐Prakash, Nachiketh; Koru‐Sengul, Tulay; Stoyanova, Radka; Pollack, Alan; Kava, Bruce R.; Gonzalgo, Mark L.; Ritch, Chad R.; Parekh, Dipen J.

doi:10.1371/journal.pone.0201384

Cited by 43 publications

(45 citation statements)

References 9 publications

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“…A mixed approach can also be used. ables for biopsy avoidance in most PI-RADS category 2 cases and in some PI-RADS category 3 cases suggests that PSA density, family history, other biomarkers (24,45), and risk calculator scores (15,20) may be helpful (46). Several investigators found that lower PSA density improves the negative predictive value of MRI (11,33,42,(47)(48)(49).…”

Section: Key Pointsmentioning

confidence: 99%

PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway

Padhani¹,

Barentsz²,

Villeirs³

et al. 2019

Radiology

187

118

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he current version of the Prostate Imaging Reporting and Data System (PI-RADS) was formulated on experience gained from PI-RADS version 1, accumulated scientific evidence, and expert consensus (1). The release of PI-RADS version 2.1 is expected to further improve observer variability (2). A recent publication evaluated multiple clinical studies, systematic analyses, and professional guidelines on their use of multiparametric MRI in prostate cancer detection (3). It showed that the test performance of multiparametric MRI-directed biopsy in the detection of prostate cancer is superior to that of systematic transrectal US-guided biopsy. High-level evidence has now established multiple benefits of MRI-directed biopsy over systematic transrectal US-guided biopsy of the prostate (4). These benefits include (a) a reduction in the number of men who need to undergo biopsy (5-9); (b) a reduction in the number of diagnoses of clinically insignificant cancers that are unlikely to cause harm (4,10), with the potential to reduce overtreatment, treatment-related complications, and active surveillance rates (6); (c) improved detection of clinically significant prostate cancers, particularly in patients with prior negative transrectal US-guided biopsy findings (4,10); and (d) improved risk stratification of diagnosed cancers owing to greater precision in tumor grade and volume determinations, which helps direct disease management. All these advantages can be achieved with fewer targeted biopsy cores per patient, potentially reducing biopsy-related morbidity (6,8,11). The purpose of this article is to focus on how multiparametric MRI results can positively impact the health of men suspected of having clinically significant prostate cancer. Who Should Undergo MRI before Biopsy? Patients chosen for MRI before biopsy include biopsynaive men with elevated serum prostate-specific antigen (PSA) levels, abnormal digital rectal examination findings, or both, and men who are deemed to have persistent elevated risk of harboring clinically significant cancers despite prior negative or nonexplanatory systematic transrectal US biopsy findings. Indications for MRI should be based on the recommendations for screening and early diagnosis of the National Comprehensive Cancer Network and the European Association of Urology (12,13). Accordingly, biopsy-naive men with lower than average risk of prostate cancer should not undergo prostate biopsy or MRI. However, limiting the options to prespecified PSA thresholds is not recommended, as there are many factors (eg, symptoms, age, race, family history, PSA kinetics, digital rectal examination findings) that in

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Section: Key Pointsmentioning

confidence: 99%

PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway

Padhani¹,

Barentsz²,

Villeirs³

et al. 2019

Radiology

187

118

View full text Add to dashboard Cite

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“…In a population of 300 men (initial and repeat biopsy) the combined use of 4K and prostate MRI showed to be superior in the prediction of csPCa (AUC 0.82) and patient’s selection for biopsy, compared to using the 4Kscore (AUC 0.70) or PI-RADS score (AUC 0.74) individually [99]. If one was to defer a biopsy in men with a negative MRI and a 4Kscore <7.5%, one would avoid 15% of the biopsies and miss 2% csPCa.…”

Section: Magnetic Resonance Imaging (Mri) As Clinical “Biomarker” mentioning

confidence: 99%

Prediction Medicine: Biomarkers, Risk Calculators and Magnetic Resonance Imaging as Risk Stratification Tools in Prostate Cancer Diagnosis

Osses

Roobol

Schoots

2019

IJMS

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This review discusses the most recent evidence for currently available risk stratification tools in the detection of clinically significant prostate cancer (csPCa), and evaluates diagnostic strategies that combine these tools. Novel blood biomarkers, such as the Prostate Health Index (PHI) and 4Kscore, show similar ability to predict csPCa. Prostate cancer antigen 3 (PCA3) is a urinary biomarker that has inferior prediction of csPCa compared to PHI, but may be combined with other markers like TMPRSS2-ERG to improve its performance. Original risk calculators (RCs) have the advantage of incorporating easy to retrieve clinical variables and being freely accessible as a web tool/mobile application. RCs perform similarly well as most novel biomarkers. New promising risk models including novel (genetic) markers are the SelectMDx and Stockholm-3 model (S3M). Prostate magnetic resonance imaging (MRI) has evolved as an appealing tool in the diagnostic arsenal with even stratifying abilities, including in the initial biopsy setting. Merging biomarkers, RCs and MRI results in higher performances than their use as standalone tests. In the current era of prostate MRI, the way forward seems to be multivariable risk assessment based on blood and clinical parameters, potentially extended with information from urine samples, as a triaging test for the selection of candidates for MRI and biopsy.

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“…The advantages of complementary use of biomarker tests and mpMRI in selecting patients for subsequent biopsy was also established by Falagario and co-workers, demonstrating that the best approach was to perform a 4K test first and, when elevated (>7.5%), perform mpMRI followed by a biopsy if mpMRI ≥ PI-RADS 3 [ 97 ]. Moreover, two recently published studies compared the combination of 4K with MRI in the prediction for hg-PCa [ 98 , 99 ]. Punnen and co-workers [ 98 ] showed that the combination of 4K with mpMRI provides a higher predictive performance for hg-PCa (AUC = 0.82; 95% CI; 0.75–0.89), compared to the 4K score (AUC = 0.70; 95% CI; 0.62–0.79) or mpMRI (AUC = 0.74; 95% CI; 0.66–0.81) alone.…”

Section: Mri and Biomarkersmentioning

confidence: 99%

Commercialized Blood-, Urinary- and Tissue-Based Biomarker Tests for Prostate Cancer Diagnosis and Prognosis

Visser

Jong

Melchers

et al. 2020

Cancers

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In the diagnosis and prognosis of prostate cancer (PCa), the serum prostate-specific antigen test is widely used but is associated with low specificity. Therefore, blood-, urinary- and tissue-based biomarker tests have been developed, intended to be used in the diagnostic and prognostic setting of PCa. This review provides an overview of commercially available biomarker tests developed to be used in several clinical stages of PCa management. In the diagnostic setting, the following tests can help selecting the right patients for initial and/or repeat biopsy: PHI, 4K, MiPS, SelectMDx, ExoDx, Proclarix, ConfirmMDx, PCA3 and PCMT. In the prognostic setting, the Prolaris, OncotypeDx and Decipher test can help in risk-stratification of patients regarding treatment decisions. Following, an overview is provided of the studies available comparing the performance of biomarker tests. However, only a small number of recently published head-to-head comparison studies are available. In contrast, recent research has focused on the use of biomarker tests in relation to the (complementary) use of multiparametric magnetic resonance imaging in PCa diagnosis.

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Optimizing patient's selection for prostate biopsy: A single institution experience with multi-parametric MRI and the 4Kscore test for the detection of aggressive prostate cancer

Cited by 43 publications

References 9 publications

PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway

PI-RADS Steering Committee: The PI-RADS Multiparametric MRI and MRI-directed Biopsy Pathway

Prediction Medicine: Biomarkers, Risk Calculators and Magnetic Resonance Imaging as Risk Stratification Tools in Prostate Cancer Diagnosis

Commercialized Blood-, Urinary- and Tissue-Based Biomarker Tests for Prostate Cancer Diagnosis and Prognosis

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