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EAU 2017

EAU 2017: Special session of the Prostate Cancer Prevention Group - Risk factors and biomarkers for screening and triage: Blood and urine-based biomarkers

London, England (UroToday.com) Professor Schalken gave a discussion on prostate cancer biomarkers but focused mainly on the long non-coding RNAs (lncRNAs) which is the prostate cancer antigen 3 (PCA3) that emerged as an attractive diagnostic / prognostic biomarker. Several recent studies have demonstrated the utility of protein coding and noncoding genes as prognostic and diagnostic biomarkers, specifically PCA3. PCA3 is over-expressed in 95% of prostate cancers, with up to 100-fold up-regulation compared to adjacent non-neoplastic cells. In clinical practice, urine-based PCA3 testing has been demonstrated to outperform the diagnostic ability of PSA in men with a prior negative biopsy resulting in FDA approval for clinical use for this indication. Urinary PCA3 showed similar performance in initial biopsy setting.

It was shown that PCA 3 has a bimodal distribution in both biopsy and radical prostatectomy tissues. In radical prostatectomy pathologies low PCA3 expression was significantly associated with high grade disease. Additionally, PCA3 was demonstrated to be a poor predictor of high grade disease in initial biopsy (Gleason score of 8 and above) with 55% sensitivity and high false negative rates. In radical prostatectomy pathologies low PCA3 was associated with adverse pathological features, recurrence and higher chance of metastatic disease. Therefore, using PCA 3 as a stand-alone test can lead to high risk of under-diagnosis of high grade disease in initial biopsy, as PCA3 is low in aggressive disease.

An additional study was done to incorporate previously identified messenger RNA (mRNA) biomarkers and traditional risk factors that could be used to identify patients with high-grade prostate cancer diagnosed on initial biopsy. It was shown that HOXC6 and DLX1 mRNA levels were good predictors for the detection of high-grade prostate cancer. Thus it was concluded that the mRNA liquid biopsy assay combined with traditional clinical risk factors in men at risk of having high-grade prostate cancer is a better patient risk stratification tool, compared with current methods in clinical practice. This could potentially reduce the number of unnecessary prostate biopsies in the future.

Dr. Schalken concluded with a short description of other available potential biomarkers available today in prostate cancer including Phi, 4k score, SelectMDX, TMPRSS2 gene fusion and HOXC6/DLX1.

Presented by: Professor Jack Schalken, Nijmegen (NL)

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto

Twitter: @GoldbergHanan

at the #EAU17 -March 24-28, 2017- London, England