Prof. Nicolaas Lumen at PROSCA 2017
(28 June 2017)
The added clinical value of biomarkers
Since PSA was introduced for prostate cancer diagnosis many new biomarker tests have been developed and brought to the market. Their aim: to overcome the limitations of PSA and improve the early detection of prostate cancer. Ideally, these biomarker tests should have a 100% accuracy, a 100% NPV and be non-invasive.
Initially, the biomarker tests only consisted of biomarkers (e.g. PCA3, PHI). However, the new generation tests, such as the 4Kscore, SelectMDx and ConfirmMDx, evolved to combining biomarkers with clinical information into risk scores. It is no surprise that these newer biomarker tests have an improved diagnostic accuracy to find clinically significant cancer compared to the old generation tests. In addition, their NPV is much higher. This is important as we want to minimise the risk of missing clinically significant cancer if the test is negative.
New generation biomarker tests perform very well to predict for high-grade prostate cancer. We see a negative predictive value of above 95% and a huge amount of biopsies that can be avoided with this strategy.
Daily practice: which biomarker to choose?
With so many different biomarkers available: how to choose the best one for your patients? An indirect comparison of key trials suggests that SelectMDx performs best. It has a very high accuracy (AUC 0.86/0.90) to find clinically significant cancer. Moreover, it has a very high NPV, resulting in only 2% risk of missing high-grade cancer. SelectMDx is also non-invasive as it is a urine-based test.
We need further evaluation to confirm the benefit of diagnostic biomarkers in daily clinical practice. But, the new generation biomarker tests seem promising tools to improve the selection of men at risk of clinically significant cancer.
• New generation diagnostic biomarkers:
o have been developed to overcome the limitations of PSA
o combine biomarkers with clinical information
o have improved ability to find clinically significant cancer and minimal risk of missing high-grade cancer
• Of all biomarker tests, SelectMDx seems to perform best
Survey diagnostic biomarkers in prostate cancer – June 2017
During his presentation, Nicolaas Lumen showed the results of a survey that he sent out to his peers. Around 300 specialists from all over the world answered his questions about their knowledge, perceptions, and use of biomarkers in prostate cancer diagnosis. In this interview, he shares his main conclusions.