PSA Based Biomarkers, Imagistic Techniques and Combined Tests for a Better Diagnostic of Localized Prostate Cancer

Abstract

Prostate cancer represents the most encountered urinary malignancy in males over 50 years old, and the second most diagnosed after lung cancer globally. Digital rectal examination and prostatic specific antigen were the long-time standard tools for diagnosis but with a significant risk of overdiagnosis and overtreatment. Magnetic resonance imaging recently entered the diagnosis process, but to this date, there is no specific biomarker that accurately indicates whether to proceed with the prostate biopsy. Research in this area has gone towards this direction, and recently, serum, urine, imagistic, tissue biomarkers, and Risk Calculators promise to help better diagnose and stratify prostate cancer. In order to eliminate the comorbidities that appear along with the diagnosis and treatment of this disease, there is a constant need to implement new diagnostic strategies. Important uro-oncology associations recommend the use of novel biomarkers in the grey area of prostate cancer, to better distinguish the next step in the diagnostic process. Although it is not that simple, they should be integrated according to the clinical policies, and it should be considered that statistical significance does not always equal clinical significance. In this review, we analyzed the contribution of prostate-specific antigen (PSA)-based biomarkers (PHI, PHID, 4Kscore, STHLM3), imagistic techniques (mp-MRI and mp-US), and combined tests in the early diagnosis process of localized prostate cancer.

Optimized Identification of High-Grade Prostate Cancer by Combining Different PSA Molecular Forms and PSA Density in a Deep Learning Model

“…On this basis, these algorithms represent a suitable platform to develop new strategies for diagnosing and staging PC. For example, not every PC patient will exhibit abnormal results in all biomarkers, so combinations can lead to better diagnostic and prognostic performance [ 42 ].…”

Diagnostic Strategies for Treatment Selection in Advanced Prostate Cancer

“…There are several biomarkers identified for PCa screening [ 10 , 11 ] ( Table 1 ) with the most ubiquitous and widely adopted being the Prostate-Specific Antigen (PSA), which was approved by the US Food and Drug Administration (FDA) in 1986. PSA screening has had a large impact on trends in PCa incidence and mortality and its widespread adoption has been scrutinized since its discovery 40 years ago [ 12 ].…”

“…The Gleason system remains an essential prognostic tool in contemporary management of PC. Its prominence has led it to being used as a correlation metric to assess new diagnostic and prognostic strategies [ 10 , 20 , 21 , 22 ].…”

Identification of the metabolic signatures of prostate cancer by mass spectrometry‐based plasma and urine metabolomics analysis

“…The cutoff value of serum PSA is 4.0 ng/ml which is widely accepted as a threshold for PCa screening. 15,16 When differentiating PCa patients from only the healthy controls, Glu/Gln turned out to have a higher sensitivity (96.6% vs. 94.4%) and a higher specificity (91.4% vs.…”