Optimizing the clinical utility of PCA3 to diagnose prostate cancer in initial prostate biopsy

Objectives: Prostate cancer is the most common cancer affecting men in Nigeria. Trans-rectal ultrasound-guided biopsy of the prostate is routinely performed to diagnose prostate cancer. Though safe, prostate biopsy may be associated with some complications. In Nigeria, there are scanty national guidelines on prophylactic measures and techniques in prostate biopsy. The aim of the study was to assess the pre-biopsy prophylactic measures and biopsy protocols employed by Nigerian Urologists. Material and Methods: A survey questionnaire was distributed during the 2019 Annual General Meeting of the Nigerian Association of Urologic Surgeons and information collected on the biopsy route, use of anesthesia, antibiotic prophylaxis, number of samples taken, and possible complications. Results: A total of 72 urologists participated in the study. Bowel preparation was performed by 10 (13.9%) participants for a duration of 1–3 days. All urologists used the transrectal route and anesthesia was given by all. Prophylactic antibiotics were given by all participants. Our participants administered antibiotic prophylaxis for a period of 1, 3, 5, or 7 days (4.2%, 23.6%, 43.1%, and 22.2%, respectively). Ciprofloxacin/metronidazole combination was most commonly prescribed (70.8%). Most urologists (69.4%) commonly take between 8 and 12 core tissues per biopsy session. The most common complication was hemorrhage (43.1%), followed by perineal pain (40.3%). Conclusion: There is a lack of evenness in pre-biopsy prophylactic measures and biopsy protocol among Nigerian Urologists. There is a need for a Nigerian guideline to elucidate the most appropriate antibiotic(s), route of administration and duration of treatment, the preferred anesthesia type, and the number of core-tissues that are appropriate.

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Clinical utility of biomarkers 4K score, SelectMDx and ExoDx with MRI for the detection of high-grade prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.307 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 307-307

Author(s):

Vittorio Fasulo ◽

Claire Marie de la Calle ◽

Janet E. Cowan ◽

Annika Herlemann ◽

Carissa Chu ◽

...

Keyword(s):

Prostate Cancer ◽

Logistic Regression ◽

Prostate Biopsy ◽

Clinical Utility ◽

Predictive Ability ◽

Added Value ◽

Gleason Grade ◽

High Grade ◽

Prostate Mri ◽

New Biomarkers

307 Background: Although adoption of new biomarkers and MRI has become widespread, their utility when deciding to biopsy is unclear. We aim to evaluate and compare 4K, SelectMDx, ExoDx and their added value when combined with prostate MRI in the detection of high-grade prostate cancer (HG PC) and avoidance of unnecessary biopsies. Methods: Patients referred for consideration of prostate biopsy at UCSF between 2016-2019 were enrolled and had either 4K, SelectMDx or ExoDx testing with/without MRI. Logistic regression and AUC were used to determine the performance of each biomarker in detecting HG PC (≥Gleason grade (GG) 3+4). In the subgroup of patients that underwent biopsy, with PSA 2.5-10 and negative DRE, we determined the number of avoided unnecessary biopsies (with GG 3+3 cancer or no cancer) and missed HG PC for each biomarker with/without MRI. Results: A total of 896 patients were enrolled, 457 were biopsied. Mean age was 65.5 years, median PSA was 6.32. Logistic regression showed that having an abnormal biomarker score or PI-RADS 4/5 on MRI (P4/5) was strongly associated with finding HG PC: 4K OR 12.9 (CI 4.58-36.1), ExoDx OR 14.7 (CI 3.31-65.3), SelectMDx OR 3.62 (CI 1.44-9.11), P4/5 OR 6.20 (CI 3.93-9.79), TRUS ≥T2a OR 4.33 (CI 2.78-6.75), PSAD >0.15 OR 4.01 (CI 2.59-6.20), p<0.01). Combining biomarker and P4/5 lesion on MRI increased AUC for detecting HG PC. In the biopsy subgroup, a normal 4K or ExoDx test missed only 4-5% HG PC, while an abnormal test resulted in avoiding 14-20% unnecessary biopsies. Combining MRI with ExoDx or 4K missed 0-1.43% HG PC but avoided only 7-9% unnecessary biopsies (Table). Conclusions: 4K and ExoDx outperformed MRI and SelectMDx but combining the biomarkers with MRI resulted in the best predictive ability for detecting HG PC. Negative MRI avoided more biopsies than a normal 4K or ExoDxbut missed more aggressive cancers. Our data suggest that MRI alone is not sensitive enough to detect all HG PC and that 4K or ExoDx testing alone could be sufficient when deciding to proceed with biopsy.[Table: see text]

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Is Prostate Biopsy Essential to Diagnose Prostate Cancer in the Older Patient with Extremely High Prostate-Specific Antigen?

Korean Journal of Urology ◽

10.4111/kju.2012.53.2.82 ◽

2012 ◽

Vol 53 (2) ◽

pp. 82 ◽

Cited By ~ 7

Author(s):

Jee Young Jang ◽

Young Sig Kim

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Prostate Biopsy ◽

Specific Antigen ◽

Older Patient ◽

Diagnose Prostate Cancer

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Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Alone or Combined with Prostate-Specific Antigen for the Diagnosis of Clinically Significant Prostate Cancer

10.21203/rs.3.rs-100942/v1 ◽

2020 ◽

Author(s):

Sat Prasad Nepal ◽

Takehiko Nakasato ◽

Yoshio Ogawa ◽

Yoshihiro Nakagami ◽

Takeshi Shichijo ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Gleason Score ◽

Prostate Biopsy ◽

Specific Antigen ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Diagnose Prostate Cancer ◽

Clinically Significant ◽

Insignificant Prostate Cancer

Abstract Background: Many patients undergo unwanted prostate biopsy due to unreliability of prostate-specific antigen (PSA). PSA density (PSAD), free PSA, free-to-total PSA ratio, prebiopsy MRI are used to diagnose prostate cancer (PCa). Since 1863, correlations between inflammation and cancer have been identified and explored; thus, the role of various blood parameters in detecting cancer has been studied, especially neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Here, we evaluated whether these parameters before prostate biopsy can diagnose prostate cancer in our hospital.Methods: We conducted a retrospective study from January 2014 to January 2018. Prostate cancer patients were divided into significant cancer (Gleason Score ≥ 7) and insignificant cancer (Gleason Score < 7). NLR, PLR, and other clinical parameters were taken before the prostate biopsy. We then analyzed the associations of NLR and PLR alone or with PSA, with significant prostate cancer. Results: We included 463 patients, of whom 60.3% (279) had prostate cancer and 75.6 % (211) had a Gleason score (GS) of ≥ 7. PSA and PSAD in the clinically significant prostate cancer patient group were around two times more than those in the insignificant prostate cancer group. PV, NLR, PLR, and combined markers were more in the GS ≥ 7 population group. PSA combined with PLR (PPLR) and PSA with NLR (PNLR) had better area under a curve (AUC) (0.732 and 0.730, resp.), with statistical significance, than PSA, NLR, and PLR alone (0.723, 0.585, and 0.590). In the multivariate analysis using separate models with PSA and NLR or PLR compared to age, DRE-positive lesions, PV, PSAD; PNLR, and PPLR were statistically significant in finding aggressive prostate cancer. When combined markers were used together, despite the high correlations, PSA and NLR were nearly significant (p = 0.062) in detecting the GS ≥ 7 population.Conclusion: The combined use of PSA with PLR and PSA with NLR helps detect the differences between clinically significant and insignificant prostate cancer.

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Clinical utility of prostate-specific antigen mass ratio for prediction of prostate cancer detection on a repeated prostate biopsy

International braz j urol ◽

10.1590/s1677-5538.ibju.2014.04.06 ◽

2014 ◽

Vol 40 (4) ◽

pp. 484-492 ◽

Cited By ~ 1

Author(s):

Won Ki Lee ◽

Sangchul Lee ◽

Sung Kyu Hong ◽

Sang Eun Lee ◽

Won Suk Choi ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Cancer Detection ◽

Prostate Biopsy ◽

Clinical Utility ◽

Specific Antigen ◽

Mass Ratio ◽

Prostate Cancer Detection

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Clinical utility study of confirms mdx for prostate cancer in a community urology practice.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.94 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 94-94

Author(s):

Paul Yonover ◽

Sandra Steyaert ◽

Justin J. Cohen ◽

Celeste Ruiz ◽

Karolina Grafczynska ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Prostate Biopsy ◽

Clinical Utility ◽

Unmet Need ◽

Repeat Biopsy ◽

Entire Study ◽

Study Population ◽

The Impact

94 Background: There is an unmet need for methods to better identify patients most likely to benefit from repeat prostate biopsy after an initial negative biopsy. ConfirmMDx is a molecular test clinically validated for detection of prostate cancer (PCa) in tissue from PCa-negative biopsies. In this clinical utility study, we evaluated the impact of ConfirmMDx on the management of patients being considered for repeat prostate biopsy in a community urology practice. Methods: The study population consisted of 605 men with a prior PCa-negative prostate biopsy, who were counseled on the need to undergo repeat biopsy at a large community urology practice due to persistent elevated risk of PCa. All tissue cores from each PCa-negative patient were tested with the ConfirmMDx methylation-specific PCR test, and positive or negative ConfirmMDx results based on the presence or absence of GSTP1, APC or RASSF1 methylation in the biopsy tissue. ConfirmMDx results were provided to the physician for use in repeat biopsy decision-making. Medical record review was conducted at a minimum of nine months after ConfirmMDx results were reported. Results: Of the 605 subjects enrolled, 308 (51%) had a negative ConfirmMDx test result and 297 (49%) were positive. For the entire study population, average age was 64 (median 64, interquartile range 59 to 69), average serum PSA level 6.8 ng/mL (5.7, 4.3 to 8.1). The median follow-up for both Confirm positives and negatives was 10 months post-testing. Repeat biopsy rates for ConfirmMDx positive and negative men were 32.3% (96/297) and 5.8% (15/308), respectively (P < 0.001). For patients who received a biopsy during the follow-up period, the time between ConfirmMDx and repeat biopsy was shorter for ConfirmMDx positive men versus ConfirmMDx negatives (median 4 vs. 8 months, P = 0.007). Conclusions: In this utility study, ConfirmMDx had a significant impact on repeat prostate biopsy decision-making in a U.S. community urology setting. Repeat biopsy rates in ConfirmMDx positive men were six-fold higher than in ConfirmMDx negatives. These results reflect the clinical utility of ConfirmMDx for biopsy decision-making in real world clinical practice.

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