SelectMDx and Multiparametric Magnetic Resonance Imaging of the Prostate for Men Undergoing Primary Prostate Biopsy: A Prospective Assessment in a Multi-Institutional Study

Abstract

Prostate-specific antigen (PSA) testing as the sole indication for prostate biopsy lacks specificity, resulting in overdiagnosis of indolent prostate cancer (PCa) and missing clinically significant PCa (csPCa). SelectMDx is a biomarker-based risk score to assess urinary HOXC6 and DLX1 mRNA expression combined with traditional clinical risk factors. The aim of this prospective multi-institutional study was to evaluate the diagnostic accuracy of SelectMDx and its association with multiparametric magnetic resonance (mpMRI) when predicting PCa in prostate biopsies. Overall, 310 consecutive subjects were included. All patients underwent mpMRI and SelectMDx prior to prostate biopsy. SelectMDx and mpMRI showed sensitivity and specificity of 86.5% vs. 51.9%, and 73.8% vs. 88.3%, respectively, in predicting PCa at biopsy, and 87.1% vs. 61.3%, and 63.7% vs. 83.9%, respectively, in predicting csPCa at biopsy. SelectMDx was revealed to be a good predictor of PCa, while with regards to csPCa detection, it was demonstrated to be less effective, showing results similar to mpMRI. With analysis of strategies assessed to define the best diagnostic strategy to avoid unnecessary biopsy, SelectMDx appeared to be a reliable pathway after an initial negative mpMRI. Thus, biopsy could be proposed for all cases of mpMRI PI-RADS 4–5 score, and to those with Prostate Imaging-Reporting and Data System (PI-RADS) 1–3 score followed by a positive SelectMDx.

Prostate Cancer Radiogenomics—From Imaging to Molecular Characterization

“…Additionally, MRI has been proven to provide higher staging accuracy compared to digital rectal examination (DRE), allowing a more conservative dissection in patients undergoing RP [ 9 ]. On the other hand, while Gleason grading and histological analysis are based on glandular architecture and the phenotypic appearance of PCa, novel techniques for the high-throughput sequencing of ribonucleic acid (RNA) and deoxyribonucleic acid (DNA) extracted from cancer cells helped to characterize PCa at a genotypic level [ 10 ]. Being the latest studied in PCa genomics, the concept of the heterogeneity of PCa, the intratumoral modifications, clonal and subclonal alterations, microheterogeneity, macroheterogeneity, the multifocal nature of PCa, and the inter-tumoral heterogeneity need to be matched between imaging and molecular pathology, for establishing the clinical implications [ 11 , 12 , 13 ].…”

Evaluation of the Predictive Role of Blood-Based Biomarkers in the Context of Suspicious Prostate MRI in Patients Undergoing Prostate Biopsy

“…However, in contrast to our cohort, their study included more patients with equivocal (PI-RADS 3) MRI lesions; PSA (median 7.8-7.9 ng/mL), age (median 65-67 years), and other clinical variables were similar to those of our cohort [24]. In the future, new tools such as artificial intelligence with radiomics may limit the MRI inter-reader variability and further enhance risk stratification in patients with suspicious MRI [19,20,[25][26][27].…”

“…In the era of precision medicine, with new imaging modalities and biomarkers, there is a persisting need to further improve pre-biopsy risk stratification. Negative and positive predictive values of MRI and single biomarkers highly depend on disease prevalence; therefore, combined strategies are needed [2,19,20]. Our model and the corresponding nomogram combining readily available biomarkers, including DRE, age, PI-RADS, and PSAD, revealed that even in patients with suspicious MRI, it is possible to include or exclude, with over 82% accuracy, the probability of significant PCa.…”

The Circular RNA circXPO1 Promotes Tumor Growth via Sponging MicroRNA-23a in Prostate Carcinoma

“…There is still no consensus on whether this screening test can significantly reduce the mortality of prostate cancer (18). In addition, the pathogenesis and molecular mechanisms of invasion and metastasis of prostate cancer are still unclear (19,20). It is important to identify genetic drivers of prostate cancer so that new biomarkers can be developed to stratify the risk and aggressiveness of prostate cancer during screening.…”