Personalised Prostate Cancer Diagnosis: Evaluating Biomarker-based Approaches to Reduce Unnecessary Magnetic Resonance Imaging and Biopsy Procedures
Risk calculators, and blood or urine biomarkers can reduce up to half of magnetic resonance imaging (MRI) scans while missing <16% of clinically significant prostate cancer (csPCa) cases. Their performance varies between populations. In case of equivocal MRI results or Prostate Imaging Reporting...
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| Published in | European urology open science (Online) Vol. 75; pp. 106 - 119 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Netherlands
Elsevier B.V
01.05.2025
Elsevier |
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| Online Access | Get full text |
| ISSN | 2666-1683 2666-1691 2666-1683 |
| DOI | 10.1016/j.euros.2025.03.006 |
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| Abstract | Risk calculators, and blood or urine biomarkers can reduce up to half of magnetic resonance imaging (MRI) scans while missing <16% of clinically significant prostate cancer (csPCa) cases. Their performance varies between populations. In case of equivocal MRI results or Prostate Imaging Reporting and Data System 3 lesions, these can reduce up to 72% of biopsies while missing up to 13% of csPCa cases. A personalised approach, tailored to individual patient characteristics and the availability of local resources, is recommended to optimise both resource allocation and detection of cancer.
Efforts made over the last decade for the detection of prostate cancer (PCa) have revolutionised disease diagnostics, and implementation of prebiopsy magnetic resonance imaging (MRI) has received widespread acceptance. However, universal adoption of prebiopsy MRI and the benefits achieved have been limited by availability and equivocal MRI findings. This review aims to evaluate the latest evidence on the role of existing PCa risk calculators (RCs), and blood and urinary biomarkers as part of the diagnostic algorithm to improve the diagnosis of clinically significant PCa (csPCa) and reduce unnecessary MRI procedures and biopsies. We will also evaluate the potential of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) to enhance sensitivity and specificity for PCa diagnosis, complement MRI, and refine biopsy strategies within the diagnostic pathway.
We performed a narrative review using the PubMed/MEDLINE database, which included papers published between January 2014 and June 2024. The outcome measures included rates of reduced diagnoses of nonsignificant PCa (defined as International Society of Urological Pathology [ISUP] grade group 1) cases, diagnoses of csPCa (defined as ISUP grade group ≥2) cases missed, and MRI scans and prostate biopsies avoided.
In men with abnormal prostate-specific antigen (PSA) levels, further risk stratification using RCs, or blood or urine biomarkers can reduce up to 16–51% MRI scans, while missing 1–16% csPCa cases. In case of equivocal MRI results or Prostate Imaging Reporting and Data System 3 lesions, RCs or biomarkers could reduce up to 72% of biopsies, while missing only 3–13% csPCa cases. PSMA PET has emerging potential to improve csPCa prediction in combination with MRI and may further reduce unnecessary biopsies. A limitation of this study is that this is a narrative but not a systematic review.
RCs and biomarkers have been demonstrated to enhance the performance and efficiency of MRI in detecting csPCa in men with elevated PSA levels. PSMA PET shows promise in detecting csPCa, complementing MRI and refining biopsy indications.
In men with a suspicion of prostate cancer, magnetic resonance imaging prostate scans are effective in predicting clinically relevant cancer, but challenges including availability and equivocal scans exist. A personalised approach by adding one or more of clinical risk calculators, blood or urine biomarkers, or even novel imaging techniques such as positron emission tomography scans may improve cancer prediction further and reduce unnecessary scans and biopsies. |
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| AbstractList | Risk calculators, and blood or urine biomarkers can reduce up to half of magnetic resonance imaging (MRI) scans while missing <16% of clinically significant prostate cancer (csPCa) cases. Their performance varies between populations. In case of equivocal MRI results or Prostate Imaging Reporting and Data System 3 lesions, these can reduce up to 72% of biopsies while missing up to 13% of csPCa cases. A personalised approach, tailored to individual patient characteristics and the availability of local resources, is recommended to optimise both resource allocation and detection of cancer. Background and objective: Efforts made over the last decade for the detection of prostate cancer (PCa) have revolutionised disease diagnostics, and implementation of prebiopsy magnetic resonance imaging (MRI) has received widespread acceptance. However, universal adoption of prebiopsy MRI and the benefits achieved have been limited by availability and equivocal MRI findings. This review aims to evaluate the latest evidence on the role of existing PCa risk calculators (RCs), and blood and urinary biomarkers as part of the diagnostic algorithm to improve the diagnosis of clinically significant PCa (csPCa) and reduce unnecessary MRI procedures and biopsies. We will also evaluate the potential of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) to enhance sensitivity and specificity for PCa diagnosis, complement MRI, and refine biopsy strategies within the diagnostic pathway. Methods: We performed a narrative review using the PubMed/MEDLINE database, which included papers published between January 2014 and June 2024. The outcome measures included rates of reduced diagnoses of nonsignificant PCa (defined as International Society of Urological Pathology [ISUP] grade group 1) cases, diagnoses of csPCa (defined as ISUP grade group ≥2) cases missed, and MRI scans and prostate biopsies avoided. Key findings and limitations: In men with abnormal prostate-specific antigen (PSA) levels, further risk stratification using RCs, or blood or urine biomarkers can reduce up to 16–51% MRI scans, while missing 1–16% csPCa cases. In case of equivocal MRI results or Prostate Imaging Reporting and Data System 3 lesions, RCs or biomarkers could reduce up to 72% of biopsies, while missing only 3–13% csPCa cases. PSMA PET has emerging potential to improve csPCa prediction in combination with MRI and may further reduce unnecessary biopsies. A limitation of this study is that this is a narrative but not a systematic review. Conclusions and clinical implications: RCs and biomarkers have been demonstrated to enhance the performance and efficiency of MRI in detecting csPCa in men with elevated PSA levels. PSMA PET shows promise in detecting csPCa, complementing MRI and refining biopsy indications. Patient summary: In men with a suspicion of prostate cancer, magnetic resonance imaging prostate scans are effective in predicting clinically relevant cancer, but challenges including availability and equivocal scans exist. A personalised approach by adding one or more of clinical risk calculators, blood or urine biomarkers, or even novel imaging techniques such as positron emission tomography scans may improve cancer prediction further and reduce unnecessary scans and biopsies. Risk calculators, and blood or urine biomarkers can reduce up to half of magnetic resonance imaging (MRI) scans while missing <16% of clinically significant prostate cancer (csPCa) cases. Their performance varies between populations. In case of equivocal MRI results or Prostate Imaging Reporting and Data System 3 lesions, these can reduce up to 72% of biopsies while missing up to 13% of csPCa cases. A personalised approach, tailored to individual patient characteristics and the availability of local resources, is recommended to optimise both resource allocation and detection of cancer. Efforts made over the last decade for the detection of prostate cancer (PCa) have revolutionised disease diagnostics, and implementation of prebiopsy magnetic resonance imaging (MRI) has received widespread acceptance. However, universal adoption of prebiopsy MRI and the benefits achieved have been limited by availability and equivocal MRI findings. This review aims to evaluate the latest evidence on the role of existing PCa risk calculators (RCs), and blood and urinary biomarkers as part of the diagnostic algorithm to improve the diagnosis of clinically significant PCa (csPCa) and reduce unnecessary MRI procedures and biopsies. We will also evaluate the potential of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) to enhance sensitivity and specificity for PCa diagnosis, complement MRI, and refine biopsy strategies within the diagnostic pathway. We performed a narrative review using the PubMed/MEDLINE database, which included papers published between January 2014 and June 2024. The outcome measures included rates of reduced diagnoses of nonsignificant PCa (defined as International Society of Urological Pathology [ISUP] grade group 1) cases, diagnoses of csPCa (defined as ISUP grade group ≥2) cases missed, and MRI scans and prostate biopsies avoided. In men with abnormal prostate-specific antigen (PSA) levels, further risk stratification using RCs, or blood or urine biomarkers can reduce up to 16–51% MRI scans, while missing 1–16% csPCa cases. In case of equivocal MRI results or Prostate Imaging Reporting and Data System 3 lesions, RCs or biomarkers could reduce up to 72% of biopsies, while missing only 3–13% csPCa cases. PSMA PET has emerging potential to improve csPCa prediction in combination with MRI and may further reduce unnecessary biopsies. A limitation of this study is that this is a narrative but not a systematic review. RCs and biomarkers have been demonstrated to enhance the performance and efficiency of MRI in detecting csPCa in men with elevated PSA levels. PSMA PET shows promise in detecting csPCa, complementing MRI and refining biopsy indications. In men with a suspicion of prostate cancer, magnetic resonance imaging prostate scans are effective in predicting clinically relevant cancer, but challenges including availability and equivocal scans exist. A personalised approach by adding one or more of clinical risk calculators, blood or urine biomarkers, or even novel imaging techniques such as positron emission tomography scans may improve cancer prediction further and reduce unnecessary scans and biopsies. Take Home MessageRisk calculators, and blood or urine biomarkers can reduce up to half of magnetic resonance imaging (MRI) scans while missing <16% of clinically significant prostate cancer (csPCa) cases. Their performance varies between populations. In case of equivocal MRI results or Prostate Imaging Reporting and Data System 3 lesions, these can reduce up to 72% of biopsies while missing up to 13% of csPCa cases. A personalised approach, tailored to individual patient characteristics and the availability of local resources, is recommended to optimise both resource allocation and detection of cancer. Efforts made over the last decade for the detection of prostate cancer (PCa) have revolutionised disease diagnostics, and implementation of prebiopsy magnetic resonance imaging (MRI) has received widespread acceptance. However, universal adoption of prebiopsy MRI and the benefits achieved have been limited by availability and equivocal MRI findings. This review aims to evaluate the latest evidence on the role of existing PCa risk calculators (RCs), and blood and urinary biomarkers as part of the diagnostic algorithm to improve the diagnosis of clinically significant PCa (csPCa) and reduce unnecessary MRI procedures and biopsies. We will also evaluate the potential of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) to enhance sensitivity and specificity for PCa diagnosis, complement MRI, and refine biopsy strategies within the diagnostic pathway.Background and objectiveEfforts made over the last decade for the detection of prostate cancer (PCa) have revolutionised disease diagnostics, and implementation of prebiopsy magnetic resonance imaging (MRI) has received widespread acceptance. However, universal adoption of prebiopsy MRI and the benefits achieved have been limited by availability and equivocal MRI findings. This review aims to evaluate the latest evidence on the role of existing PCa risk calculators (RCs), and blood and urinary biomarkers as part of the diagnostic algorithm to improve the diagnosis of clinically significant PCa (csPCa) and reduce unnecessary MRI procedures and biopsies. We will also evaluate the potential of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) to enhance sensitivity and specificity for PCa diagnosis, complement MRI, and refine biopsy strategies within the diagnostic pathway.We performed a narrative review using the PubMed/MEDLINE database, which included papers published between January 2014 and June 2024. The outcome measures included rates of reduced diagnoses of nonsignificant PCa (defined as International Society of Urological Pathology [ISUP] grade group 1) cases, diagnoses of csPCa (defined as ISUP grade group ≥2) cases missed, and MRI scans and prostate biopsies avoided.MethodsWe performed a narrative review using the PubMed/MEDLINE database, which included papers published between January 2014 and June 2024. The outcome measures included rates of reduced diagnoses of nonsignificant PCa (defined as International Society of Urological Pathology [ISUP] grade group 1) cases, diagnoses of csPCa (defined as ISUP grade group ≥2) cases missed, and MRI scans and prostate biopsies avoided.In men with abnormal prostate-specific antigen (PSA) levels, further risk stratification using RCs, or blood or urine biomarkers can reduce up to 16-51% MRI scans, while missing 1-16% csPCa cases. In case of equivocal MRI results or Prostate Imaging Reporting and Data System 3 lesions, RCs or biomarkers could reduce up to 72% of biopsies, while missing only 3-13% csPCa cases. PSMA PET has emerging potential to improve csPCa prediction in combination with MRI and may further reduce unnecessary biopsies. A limitation of this study is that this is a narrative but not a systematic review.Key findings and limitationsIn men with abnormal prostate-specific antigen (PSA) levels, further risk stratification using RCs, or blood or urine biomarkers can reduce up to 16-51% MRI scans, while missing 1-16% csPCa cases. In case of equivocal MRI results or Prostate Imaging Reporting and Data System 3 lesions, RCs or biomarkers could reduce up to 72% of biopsies, while missing only 3-13% csPCa cases. PSMA PET has emerging potential to improve csPCa prediction in combination with MRI and may further reduce unnecessary biopsies. A limitation of this study is that this is a narrative but not a systematic review.RCs and biomarkers have been demonstrated to enhance the performance and efficiency of MRI in detecting csPCa in men with elevated PSA levels. PSMA PET shows promise in detecting csPCa, complementing MRI and refining biopsy indications.Conclusions and clinical implicationsRCs and biomarkers have been demonstrated to enhance the performance and efficiency of MRI in detecting csPCa in men with elevated PSA levels. PSMA PET shows promise in detecting csPCa, complementing MRI and refining biopsy indications.In men with a suspicion of prostate cancer, magnetic resonance imaging prostate scans are effective in predicting clinically relevant cancer, but challenges including availability and equivocal scans exist. A personalised approach by adding one or more of clinical risk calculators, blood or urine biomarkers, or even novel imaging techniques such as positron emission tomography scans may improve cancer prediction further and reduce unnecessary scans and biopsies.Patient summaryIn men with a suspicion of prostate cancer, magnetic resonance imaging prostate scans are effective in predicting clinically relevant cancer, but challenges including availability and equivocal scans exist. A personalised approach by adding one or more of clinical risk calculators, blood or urine biomarkers, or even novel imaging techniques such as positron emission tomography scans may improve cancer prediction further and reduce unnecessary scans and biopsies. Efforts made over the last decade for the detection of prostate cancer (PCa) have revolutionised disease diagnostics, and implementation of prebiopsy magnetic resonance imaging (MRI) has received widespread acceptance. However, universal adoption of prebiopsy MRI and the benefits achieved have been limited by availability and equivocal MRI findings. This review aims to evaluate the latest evidence on the role of existing PCa risk calculators (RCs), and blood and urinary biomarkers as part of the diagnostic algorithm to improve the diagnosis of clinically significant PCa (csPCa) and reduce unnecessary MRI procedures and biopsies. We will also evaluate the potential of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) to enhance sensitivity and specificity for PCa diagnosis, complement MRI, and refine biopsy strategies within the diagnostic pathway. We performed a narrative review using the PubMed/MEDLINE database, which included papers published between January 2014 and June 2024. The outcome measures included rates of reduced diagnoses of nonsignificant PCa (defined as International Society of Urological Pathology [ISUP] grade group 1) cases, diagnoses of csPCa (defined as ISUP grade group ≥2) cases missed, and MRI scans and prostate biopsies avoided. In men with abnormal prostate-specific antigen (PSA) levels, further risk stratification using RCs, or blood or urine biomarkers can reduce up to 16-51% MRI scans, while missing 1-16% csPCa cases. In case of equivocal MRI results or Prostate Imaging Reporting and Data System 3 lesions, RCs or biomarkers could reduce up to 72% of biopsies, while missing only 3-13% csPCa cases. PSMA PET has emerging potential to improve csPCa prediction in combination with MRI and may further reduce unnecessary biopsies. A limitation of this study is that this is a narrative but not a systematic review. RCs and biomarkers have been demonstrated to enhance the performance and efficiency of MRI in detecting csPCa in men with elevated PSA levels. PSMA PET shows promise in detecting csPCa, complementing MRI and refining biopsy indications. In men with a suspicion of prostate cancer, magnetic resonance imaging prostate scans are effective in predicting clinically relevant cancer, but challenges including availability and equivocal scans exist. A personalised approach by adding one or more of clinical risk calculators, blood or urine biomarkers, or even novel imaging techniques such as positron emission tomography scans may improve cancer prediction further and reduce unnecessary scans and biopsies. |
| Author | Kasivisvanathan, Veeru Falagario, Ugo Chiu, Peter K.F. Wu, Xiaobo Gandaglia, Giorgio Van den Bergh, Roderick C.N. Kesch, Claudia Rajwa, Pawel Marra, Giancarlo Miszczyk, Marcin Soeterik, Timo F.W. Zattoni, Fabio Martini, Alberto Fasulo, Vittorio Maggi, Martina |
| Author_xml | – sequence: 1 givenname: Timo F.W. surname: Soeterik fullname: Soeterik, Timo F.W. email: t.soeterik@antoniusziekenhuis.nl organization: Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands – sequence: 2 givenname: Xiaobo surname: Wu fullname: Wu, Xiaobo organization: S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China – sequence: 3 givenname: Roderick C.N. surname: Van den Bergh fullname: Van den Bergh, Roderick C.N. organization: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands – sequence: 4 givenname: Claudia surname: Kesch fullname: Kesch, Claudia organization: Department of Urology, University Hospital Essen, Essen German Cancer Consortium (DKTK) University Hospital Essen, Essen, Germany – sequence: 5 givenname: Fabio surname: Zattoni fullname: Zattoni, Fabio organization: Urology Unit, Department of Surgery, Oncology, and Gastroenterology, Urologic Unit, University of Padua, Padua, Italy – sequence: 6 givenname: Ugo surname: Falagario fullname: Falagario, Ugo organization: Department of Urology, University of Foggia, Foggia, Italy – sequence: 7 givenname: Alberto surname: Martini fullname: Martini, Alberto organization: Department of Urology, University of Cincinnati, Cincinnati, OH, USA – sequence: 8 givenname: Marcin surname: Miszczyk fullname: Miszczyk, Marcin organization: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria – sequence: 9 givenname: Vittorio surname: Fasulo fullname: Fasulo, Vittorio organization: Department of Biomedical Sciences, Humanitas University, Milan, Italy – sequence: 10 givenname: Martina surname: Maggi fullname: Maggi, Martina organization: Department of Maternal-Infant and Urological Sciences, Sapienza University of Rome, Rome, Italy – sequence: 11 givenname: Veeru surname: Kasivisvanathan fullname: Kasivisvanathan, Veeru organization: Division of Surgery and Interventional Science, University College London, London, UK – sequence: 12 givenname: Pawel surname: Rajwa fullname: Rajwa, Pawel organization: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria – sequence: 13 givenname: Giancarlo surname: Marra fullname: Marra, Giancarlo organization: University Hospital S Giovanni Battista, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy – sequence: 14 givenname: Giorgio surname: Gandaglia fullname: Gandaglia, Giorgio organization: Division of Oncology/Unit of Urology, Soldera Prostate Cancer Lab, URI, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy – sequence: 15 givenname: Peter K.F. surname: Chiu fullname: Chiu, Peter K.F. email: peterchiu@surgery.cuhk.edu.hk organization: S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China |
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| Snippet | Risk calculators, and blood or urine biomarkers can reduce up to half of magnetic resonance imaging (MRI) scans while missing <16% of clinically significant... Take Home MessageRisk calculators, and blood or urine biomarkers can reduce up to half of magnetic resonance imaging (MRI) scans while missing <16% of... Efforts made over the last decade for the detection of prostate cancer (PCa) have revolutionised disease diagnostics, and implementation of prebiopsy magnetic... Background and objective: Efforts made over the last decade for the detection of prostate cancer (PCa) have revolutionised disease diagnostics, and... |
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| Title | Personalised Prostate Cancer Diagnosis: Evaluating Biomarker-based Approaches to Reduce Unnecessary Magnetic Resonance Imaging and Biopsy Procedures |
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