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. 2024 Jan 23;14(2):130.
doi: 10.3390/jpm14020130.

Investigating Efficient Risk-Stratified Pathways for the Early Detection of Clinically Significant Prostate Cancer

Juan Morote  1   2   3 , Ángel Borque-Fernando  4 , Luis M Esteban  5 , Ana Celma  1   3 , Miriam Campistol  1   2 , Berta Miró  6 , Olga Méndez  3 , Enrique Trilla  1   2   3
Affiliations

Investigating Efficient Risk-Stratified Pathways for the Early Detection of Clinically Significant Prostate Cancer

Juan Morote et al. J Pers Med. .

Abstract

Risk-stratified pathways (RSPs) are recommended by the European Association of Uro-logy (EAU) to improve the early detection of clinically significant prostate cancer (csPCa). RSPs can reduce magnetic resonance imaging (MRI) demand, prostate biopsies, and the over-detection of insignificant PCa (iPCa). Our goal is to analyze the efficacy and cost-effectiveness of several RSPs by using sequential stratifications from the serum prostate-specific antigen level and digital rectal examination, the Barcelona risk calculators (BCN-RCs), MRI, and Proclarix™. In a cohort of 567 men with a serum PSA level above 3.0 ng/mL who underwent multiparametric MRI (mpMRI) and targeted and/or systematic biopsies, the risk of csPCa was retrospectively assessed using Proclarix™ and BCN-RCs 1 and 2. Six RSPs were compared with those recommended by the EAU that, stratifying men from MRI, avoided 16.7% of prostate biopsies with a prostate imaging-reporting and data system score of <3, with 2.6% of csPCa cases remaining undetected. The most effective RSP avoided mpMRI exams in men with a serum PSA level of >10 ng/mL and suspicious DRE, following stratifications from BCN-RC 1, mpMRI, and Proclarix™. The demand for mpMRI decreased by 19.9%, prostate biopsies by 19.8%, and over-detection of iPCa by 22.7%, while 2.6% of csPCa remained undetected as in the recommended RSP. Cost-effectiveness remained when the Proclarix™ price was assumed to be below EUR 200.

Keywords: Barcelona risk calculator; Proclarix; prostate cancer; risk-stratified pathway; screening.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Receiving operating characteristic curves illustrating the discriminative ability for csPCa of the PI-RADS score, BCN-RC 1, BCN-RC 2, and Proclarix™.
Figure 2
Figure 2
Flowchart and efficacy of the currently recommended RSP-1, which stratifies men suspected of having PCa according to the PI-RADS score. Green are overall efficacy.
Figure 3
Figure 3
Flowchart and efficacy of the currently recommended RSP-2, which stratifies men suspected of having PCa according to the PI-RADS score. Green are overall efficacy.
Figure 4
Figure 4
Flowchart and efficacy of the RSP-3, based on sequential stratifications from PSA-DRE, DRE, and Proclarix™. Green is overall results.
Figure 5
Figure 5
Flowchart and efficacy of the RSP-4, based on sequential stratifications from PSA-DRE, BCN-RC 1, and BCN-RC 2. Green is overall results.
Figure 6
Figure 6
Flowchart and efficacy of the RSP-5, based on sequential stratifications PSA-DRE, Procla-rix™, and BCN-RC 2. Green is overall results.
Figure 7
Figure 7
Flowchart and efficacy of the RSP-6, based on sequential stratifications from PSA-DRE, BCN-RC 1, and Proclarix™. Green is overall results.
Figure 8
Figure 8
Flowchart and efficacy of the RSP-7, based on sequential stratifications from PSA-DRE, BCN-RC 1, mpMRI, and Proclarix™. Green is overall results.
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