Utility of Noninvasive Biomarker Testing and MRI to Predict a Prostate Cancer Diagnosis

Though prostate cancer (PC) remains the most common cancer among men, early detection is critical to limit mortality. Unfortunately, Prostate Specific Antigen (PSA) is an imperfect marker for cancer screening, with many men undergoing prostate biopsy unnecessarily. For example, the PRECISION trial reported clinically significant PC in only 26% of patients who were biopsied solely based on elevated PSA or abnormal DRE.¹ As a response to the gap created by prostate biopsy overuse when relying on PSA screening, various commercial biomarkers have been marketed to aid both physicians and patients in the decision to proceed with biopsy. While other studies have previously reported on the superior discriminatory role of a 4K score and MRI in tandem to detect clinically significant PC, the aim of our project was to assess the utility for sequential biomarker testing.² We sought to improve the diagnostic paradigm beyond contemporary practice patterns- particularly understanding if a role exists for sequential laboratory testing.

Our results certainly suggest the benefit of incorporating noninvasive biomarker testing and imaging. On regression analysis, standard clinical markers (Age, PSA, DRE) produced an Area Under the Curve (AUC) of 0.559, the addition of a single biomarker (4K Score) raised the AUC to 0.653, and the stepwise addition of a secondary biomarker (ExoDx Intelliscore) further increased the AUC to 0.766. Our final regression incorporating patient characteristics, both biomarkers and MRI yielded an AUC of 0.825.

Our findings represent an opportunity to further integrate the use of novel biomarkers and their combination with imaging into clinical practice. We hope this approach will limit the number of unnecessary and quite invasive prostate biopsies, thus saving biopsies for patients with clinically significant cancer that warrant intervention rather than surveillance. Our study is a good example of incorporating helpful tools to optimize shared physician-patient decision making in the realm of prostate cancer. It is prime time for physicians to use every tool in their armamentarium for a personalized management approach constructed on individual risk.

Written by: Ramy Youssef Yaacoub, MD & Mark Sultan, MD, Department of Urology, University of California, Irvine, Orange, CA, USA

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