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Review
. 2019 Apr 2;20(7):1637.
doi: 10.3390/ijms20071637.

Prediction Medicine: Biomarkers, Risk Calculators and Magnetic Resonance Imaging as Risk Stratification Tools in Prostate Cancer Diagnosis

Daniël F Osses  1   2 , Monique J Roobol  3 , Ivo G Schoots  4
Affiliations
Review

Prediction Medicine: Biomarkers, Risk Calculators and Magnetic Resonance Imaging as Risk Stratification Tools in Prostate Cancer Diagnosis

Daniël F Osses et al. Int J Mol Sci. .

Abstract

This review discusses the most recent evidence for currently available risk stratification tools in the detection of clinically significant prostate cancer (csPCa), and evaluates diagnostic strategies that combine these tools. Novel blood biomarkers, such as the Prostate Health Index (PHI) and 4Kscore, show similar ability to predict csPCa. Prostate cancer antigen 3 (PCA3) is a urinary biomarker that has inferior prediction of csPCa compared to PHI, but may be combined with other markers like TMPRSS2-ERG to improve its performance. Original risk calculators (RCs) have the advantage of incorporating easy to retrieve clinical variables and being freely accessible as a web tool/mobile application. RCs perform similarly well as most novel biomarkers. New promising risk models including novel (genetic) markers are the SelectMDx and Stockholm-3 model (S3M). Prostate magnetic resonance imaging (MRI) has evolved as an appealing tool in the diagnostic arsenal with even stratifying abilities, including in the initial biopsy setting. Merging biomarkers, RCs and MRI results in higher performances than their use as standalone tests. In the current era of prostate MRI, the way forward seems to be multivariable risk assessment based on blood and clinical parameters, potentially extended with information from urine samples, as a triaging test for the selection of candidates for MRI and biopsy.

Keywords: biomarker; cost-effective diagnostic pathways; magnetic resonance imaging; prostate cancer detection; risk calculator; risk stratification.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of men with elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE), with the combination of upfront risk stratification and if indicated prostate MRI and biopsy. PSA: prostate-specific antigen; DRE: digital rectal examination; PCa: prostate cancer; MRI: magnetic resonance imaging; PI-RADS: MRI suspicion score; TBx: MRI-targeted biopsy; SBx: systematic biopsy; AS: active surveillance.
See this image and copyright information in PMC

References

    1. Schroder F.H., Hugosson J., Roobol M.J., Tammela T.L., Zappa M., Nelen V., Kwiatkowski M., Lujan M., Maattanen L., Lilja H., et al. Screening and prostate cancer mortality: Results of the european randomised study of screening for prostate cancer (erspc) at 13 years of follow-up. Lancet. 2014;384:2027–2035. doi: 10.1016/S0140-6736(14)60525-0. - DOI - PMC - PubMed
    1. Pinsky P.F., Miller E., Prorok P., Grubb R., Crawford E.D., Andriole G. Extended follow-up for prostate cancer incidence and mortality among participants in the prostate, lung, colorectal and ovarian randomized cancer screening trial. BJU Int. 2018 doi: 10.1111/bju.14580. - DOI - PMC - PubMed
    1. Tsodikov A., Gulati R., Heijnsdijk E.A.M., Pinsky P.F., Moss S.M., Qiu S., de Carvalho T.M., Hugosson J., Berg C.D., Auvinen A., et al. Reconciling the effects of screening on prostate cancer mortality in the erspc and plco trials. Ann. Intern. Med. 2017;167:449–455. doi: 10.7326/M16-2586. - DOI - PMC - PubMed
    1. de Koning H.J., Gulati R., Moss S.M., Hugosson J., Pinsky P.F., Berg C.D., Auvinen A., Andriole G.L., Roobol M.J., Crawford E.D., et al. The efficacy of prostate-specific antigen screening: Impact of key components in the erspc and plco trials. Cancer. 2018;124:1197–1206. doi: 10.1002/cncr.31178. - DOI - PMC - PubMed
    1. Osses D.F., Remmers S., Schroder F.H., van der Kwast T., Roobol M.J. Results of prostate cancer screening in a unique cohort at 19yr of follow-up. Eur. Urol. 2018;75:374–377. doi: 10.1016/j.eururo.2018.10.053. - DOI - PubMed

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