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