Prostate Cancer Diagnostic Algorithm as a “Road Map” from the First Stratification of the Patient to the Final Treatment Decision

Abstract

The diagnostics of prostate cancer are currently based on three pillars: prostate biomarker panel, imaging techniques, and histological verification. This paper presents a diagnostic algorithm that can serve as a “road map”: from initial patient stratification to the final decision regarding treatment. The algorithm is based on a review of the current literature combined with our own experience. Diagnostic algorithms are a feature of an advanced healthcare system in which all steps are consciously coordinated and optimized to ensure the proper individualization of the treatment process. The prostate cancer diagnostic algorithm was created using the prostate specific antigen and in particular the Prostate Health Index in the first line of patient stratification. It then continued on the diagnostic pathway via imaging techniques, biopsy, or active surveillance, and then on to the treatment decision itself. In conclusion, the prostate cancer diagnostic algorithm presented here is a functional tool for initial patient stratification, comprehensive staging, and aggressiveness assessment. Above all, emphasis is placed on the use of the Prostate Health Index (PHI) in the first stratification of the patients as a predictor of aggressiveness and clinical stage of prostrate cancer (PCa). The inclusion of PHI in the algorithm significantly increases the accuracy and speed of the diagnostic procedure and allows to choose the optimal pathway just from the beginning. The use of advanced diagnostic techniques allows us to move towards to a more advanced level of cancer care. This diagnostics algorithm has become a standard of care in our hospital. The algorithm is continuously validated and modified based on our results.

Preanalytical stability of molecular forms of prostate‐specific antigen in serum samples (PSA, free PSA, [−2]proPSA) and their impact on fPSA/tPSA ratio and PHI

“…It is therefore extremely important to know the preanalytical conditions of individual prostate markers, so that correct decisions can be made. 20,21 The inclusion criteria of the study were established in accordance with the EAU Guidelines on Prostate Cancer. The EAU Guidelines mention the usefulness of [−2]proPSA measurements and the additional value of calculating the PHI when seeking to improve predictions regarding clinically significant prostate cancer in men with the tPSA values between 2 and 10 ng/ ml.…”

“…Treatment is decided based on the measurement of prostate biomarkers, in combination with the results of a biopsy and imaging methods. It is therefore extremely important to know the preanalytical conditions of individual prostate markers, so that correct decisions can be made 20,21 . The inclusion criteria of the study were established in accordance with the EAU Guidelines on Prostate Cancer.…”

COMBINING PROSTATE HEALTH INDEX AND ampMRI DATA (MRI SPECTROSCOPY) TO MANAGE PI-RADS LESIONS AND REDUCE EXCESSIVE BIOPSY, A SINGLE CENTER STUDY

“…This viewpoint may keep away a lot of unnecessary biopsies and definitive medical therapy if PHI and MRI would be included in the diagnostic algorithm for patients with suspected PCa to select patients for biopsy [30].…”

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

“…This approach may avoid a lot of unnecessary biopsies and definitive treatments with their related well-known side effects. 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.…”