In this study, the authors aim to assess the utility of a novel biomarker-based risk score (SelectMDx), which utilizes urinary HOXC6 and DLXI mRNA expression levels combined with traditional clinical risk factors to high-grade PCa (Gleason score ≥7) at the time of prostate biopsy, to help better risk-stratify patients and reduce unnecessary biopsies. Importantly, the risk score improved upon the PCA3 test, by working well in men with a low PSA. It was demonstrated to have an AUC of 0.90!
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Of the 174 patients, 102 (59%) had PCa detected upon biopsy, of which 54 (53%) had high-grade disease and a significantly higher SelectMDx risk score (p<0.001).
When compared to mpMRI, the median SelectMDx risk score was significantly higher in patients who had a suspicious lesion on MRI (p<0.001). For 81 mpMRIs, the Prostate Imaging Reporting and Data System (PI-RADS) classification was reported and there was a positivie correlation observed between the risk score and the PI-RADS classification – specifically for PIRADS 4-5 lesions. A Kruskal-Wallis test indicated a statistically significant difference in SelectMDx risk scores between the different PI-RADS groups (p<0.001).
Based on this the authors suggest a correlation between SelectMDx scores and mpMRI findings. However, it is important to note that mpMRI does not always imply high-risk cancer. While the findings are suggestive, a more formal study sequenced as follows needs to be done: clinical suspicion of prostate cancer SelectMDx and mpMRI mpMRI targeted biopsy. In this way, a more accurate correlation to diagnosis of clinically significant prostate cancer can be made.
Limitations / Discussion Points:
1. Correlation to mpMRI findings alone do not necessarily imply PCa diagnosis.
2. This was not a standardized exam – they only used patients that got a mpMRI for some indication. Hence it was a selected population at risk for higher-risk disease due to clinical concern.
Further studies are clearly warranted. They have completed recruitment for a prospective study in the Dutch population, entitled the 4M trial. The results will be released later this year.
Presented By: Jack Schalken, PhD, Radboud University Medical Center, Nijmegen, Netherlands
Co-Authors: Rianne J Hendriks, Marloes MG van der Leest, Peter FA Mulders, Inge MG van Oort
Institutions: Radboud University Medical Center, Nijmegen, Netherlands
Witten By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto Twitter: @tchandra_uromd at the 72nd Canadian Urological Association Annual Meeting - June 24 - 27, 2017 - Toronto, Ontario, Canada