Prostate Cancer Diagnostics Using a Combination of the Stockholm3 Blood Test and Multiparametric Magnetic Resonance Imaging

Grönberg, Henrik; Eklund, Martin; Picker, Wolfgang; Aly, Markus; Jäderling, Fredrik; Adolfsson, Jan; Landquist, Martin; Haug, Erik Skaaheim; Ström, Peter; Carlsson, Stefan; Nordström, Tobias

doi:10.1016/j.eururo.2018.06.022

Cited by 83 publications

(59 citation statements)

References 27 publications

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“…S3M was validated on 60000 subjects, showing an AUC significantly higher than PSA (AUC = 0.75 [0.73-0.77] versus 0.58 [0.57-0.60]) for the identification of high-grade tumors [46]. Of note, in a study including 532 Scandinavian patients at first biopsy, using S3M to select patients for MRI and targeted biopsy prevented 42% of biopsies, decreasing detection of indolent cancer, and maintaining a good sensitivity to identify csPCa [47].…”

Section: Comparison With Other Tests Based On Circulating Biomarkersmentioning

confidence: 99%

Beyond PSA: The Role of Prostate Health Index (phi)

Ferro

Cobelli

Lucarelli

et al. 2020

IJMS

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Background: Widespread use of prostate specific antigen (PSA) in screening procedures allowed early identification of an increasing number of prostate cancers (PCas), mainly including indolent cancer. Availability of different therapeutic strategies which have a very different impact on the patient's quality of life suggested a strong need for tools able to identify clinically significant cancer at diagnosis. Multi-parametric magnetic resonance showed very good performance in pre-biopsy diagnosis. However, it is an expensive tool and requires an experienced radiologist. In this context, a simple blood-based test is worth investigating. In this context, researchers focused their attention on the development of a laboratory test able to minimize overdiagnosis without losing the identification of aggressive tumors. Results: Recent literature data on PCa biomarkers revealed a clear tendency towards the use of panels of biomarkers or a combination of biomarkers and clinical variables. Phi, the 4Kscore, and Stockholm3 as circulating biomarkers and the Mi-prostate score, Exo DX Prostate, and Select MD-X as urinary biomarker-based tests have been developed. In this scenario, phi is worthy of attention as a noninvasive test significantly associated with aggressive PCa. Conclusions: Literature data showed that phi had good diagnostic performance to identify clinically significant (cs) PCa, suggesting that it could be a useful tool for personalized treatment decision-making. In this review, phi potentialities, limitations, and comparisons with other blood-and urinary-based tests were explored.

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Section: Comparison With Other Tests Based On Circulating Biomarkersmentioning

confidence: 99%

Beyond PSA: The Role of Prostate Health Index (phi)

Ferro

Cobelli

Lucarelli

et al. 2020

IJMS

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“…We did not compare performance of the phi with other biomarkers as these were not available to us. The Stockholm3 study showed very comparable results with a 10% risk threshold reducing mpMRI and biopsies by 40% and missing 8% of cancers [14]. A cost analysis was not published.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequent studies have sought to combine biomarkers with mpMRI with all showing consistently better results than biomarkers alone but often in a retrospective setting. One notable prospective study combined the Stockholm3 test with mpMRI and showed the combination was more accurate than each individual test in detecting prostate cancer [14]. These studies, however, have generally not considered the incremental cost implications and therefore whether tests can be used sequentially [11,31].…”

Section: Discussionmentioning

confidence: 99%

“…As a result, the European Association of Urology (EAU), amongst other bodies, has called for research into pre-MRI triage tests to refine and improve the use of mpMRI [11]. A few studies have now tested combinations of biomarkers and imaging in controlled trials [12][13][14][15]. On-line risk calculators are also available and have recently been updated to include mpMRI data in their predictive algorithms [16].…”

Section: Introductionmentioning

confidence: 99%

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Clinical utility and cost modelling of the phi test to triage referrals into image-based diagnostic services for suspected prostate cancer: the PRIM (Phi to RefIne Mri) study

Kim

Boxall

George

et al. 2020

BMC Med

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Background: The clinical pathway to detect and diagnose prostate cancer has been revolutionised by the use of multiparametric MRI (mpMRI pre-biopsy). mpMRI however remains a resource-intensive test and is highly operator dependent with variable effectiveness with regard to its negative predictive value. Here we tested the use of the phi assay in standard clinical practice to pre-select men at the highest risk of harbouring significant cancer and hence refine the use of mpMRI and biopsies. Methods: A prospective five-centre study recruited men being investigated through an mpMRI-based prostate cancer diagnostic pathway. Test statistics for PSA, PSA density (PSAd) and phi were assessed for detecting significant cancers using 2 definitions: ≥ Grade Group (GG2) and ≥ Cambridge Prognostic Groups (CPG) 3. Cost modelling and decision curve analysis (DCA) was simultaneously performed. Results: A total of 545 men were recruited and studied with a median age, PSA and phi of 66 years, 8.0 ng/ml and 44 respectively. Overall, ≥ GG2 and ≥ CPG3 cancer detection rates were 64% (349/545), 47% (256/545) and 32% (174/545) respectively. There was no difference across centres for patient demographics or cancer detection rates. The overall area under the curve (AUC) for predicting ≥ GG2 cancers was 0.70 for PSA and 0.82 for phi. AUCs for ≥ CPG3 cancers were 0.81 and 0.87 for PSA and phi respectively. AUC values for phi did not differ between centres suggesting reliability of the test in different diagnostic settings. Pre-referral phi cutoffs between 20 and 30 had NPVs of 0.85-0.90 for ≥ GG2 cancers and 0.94-1.0 for ≥ CPG3 cancers. A strategy of mpMRI in all and biopsy only positive lesions reduced unnecessary biopsies by 35% but missed 9% of ≥ GG2 and 5% of ≥ CPG3 cancers. Using PH ≥ 30 to rule out referrals missed 8% and 5% of ≥ GG2 and ≥ CPG3 cancers (and reduced unnecessary biopsies by 40%). This was achieved however with 25% fewer mpMRI. Pathways incorporating PSAd missed fewer cancers but necessitated more unnecessary biopsies. The phi strategy had the lowest mean costs with DCA demonstrating net clinical benefit over a range of thresholds. Conclusion: phi as a triaging test may be an effective way to reduce mpMRI and biopsies without compromising detection of significant prostate cancers.

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“…We performed an analysis of Scandinavian men from multiple sites referred for prostate cancer diagnostic evaluation. A total of 467 men with no significant lesions on pre‐biopsy MRI were included (103 from the prospective, multicentre Stockholm3 phase 1 study [6] and 364 consecutive patients from Stavanger, Norway). All men underwent a biparametric MRI without dynamic contrast.…”

Section: Figmentioning

confidence: 99%