Publication

A urinary biomarker-based risk score correlates with multiparametric MRI for prostate cancer detection

SelectMDx risk scores correlate with multiparametric MRI outcomes

 

Hendriks RJ et al. Prostate 2017; doi: 10.1002/pros.23401

 

What was studied?

This study assessed the association between SelectMDx and multiparametric (mp)MRI outcomes.

 

What were the main outcomes?

The median SelectMDx risk score was statistically significantly higher in men who had a suspicious significant lesion on mp-MRI (PI-RADS 4-5) compared to those who had no suspicion of significant prostate cancer (PI-RADS 1-2-3) (P<0.01). Moreover, a positive correlation was found between the SelectMDx risk score and the PI-RADS grade 3-4-5. The difference in SelectMDx score between PI-RADS 3 and PI-RADS 4 and between PI-RADS 4 and PI-RADS 5 was statistically significant (P<0.01). For predicting the mp-MRI outcome, the AUC of SelectMDx was 0.83 compared to 0.66 for PSA and 0.65 for PCA3.

(PI-RADS: Prostate Imaging Reporting and Data System)

 

What was concluded?

This study showed that SelectMDx risk scores correlate with mp-MRI outcomes and PI-RADS grading, outperforming PCA3. This suggests that SelectMDx can help to select patients for further diagnostics (such as MRI) and identify men at risk for clinically significant prostate cancer.

 

How was the study performed?

This was a retrospective cohort study that included 172 patients (84% with initial biopsy) that were previously included in the SelectMDx validation study1. Urine was collected after a DRE for the SelectMDx test. Patients underwent a mp-MRI for persistent suspicion of prostate cancer after negative biopsies or for staging after finding prostate cancer on biopsy. PI-RADS v2 was used for grading the lesions in all three mp-MRI sequences (T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging) using a 3 T MR scanner. All mp-MRIs were centrally reviewed by one experienced radiologist blinded for SelectMDx and biopsy outcomes.

 

  1. Van Neste L et al. Eur Urol 2016;70:740-8

Editor comment

The current study evaluates one of the potential applications of the SelectMDx score in the clinical scenario. Multiparametric (mp)MRI plays an important role in the identification of patients at higher risk of harbouring clinically significant disease at prostate biopsy. Nonetheless, the use of mpMRI in all men with increased PSA levels would result into unsustainable costs for the healthcare system. Moreover, a substantial proportion of men with increased PSA levels eventually have a negative mpMRI. The integration of information coming from biomarkers such as SelectMDx and clinical parameters might play an important role for the identification of patients who are candidates for mpMRI and prostate biopsy. In particular, mpMRI could be performed exclusively in men with a higher risk of prostate cancer according to biomarker scores and clinical parameters. The current study is one of the first studies to present evidence supporting the utility of the integration of information coming from mpMRI and biomarkers in clinical practice.

Photo Dr. Giorgio Gandaglia
Dr. Giorgio Gandaglia
Vita-Salute San Raffaele University, Milan, Italy

The role of biomarker tests is important since currently many patients get a MRI before biopsy although this is often unnecessary.

Photo Prof. Christian Stief
Prof. Christian Stief
Ludwig-Maximilians-University, Munich, Germany

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