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Fiorella D, Marenco JL, Mascarós JM, Borque-Fernando Á, Esteban LM, Calatrava A, Pastor B, López-Guerrero JA, Rubio-Briones J. Role of PCA3 and SelectMDx in the optimization of active surveillance in prostate cancer. Actas Urol Esp 2021; 45:439-446. [PMID: 34148844 DOI: 10.1016/j.acuroe.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION & OBJECTIVES A not negligible percentage of patients included in active surveillance (AS) for low and very low risk prostate cancer (PCa) are reclassified in the confirmatory biopsy or have disease progression during follow-up. Our aim is to evaluate the role of PCA3 and SelectMDx, in an individual and combined way, in the prediction of pathological progression (PP) in a standard AS program. MATERIALS & METHODS Prospective and observational study comprised of 86 patients enrolled in an AS program from 2009 to 2019, with results for PCA3 and SelectMDx previous to PCa diagnosis or during their confirmatory period. Univariate and multivariate analysis were performed to correlate PCA3 and SelectMDx scores as well as clinical and pathological variables with PP-free survival (PPFS). The most reliable cut-offs for both biomarkers in the context of AS were defined. RESULTS SelectMDx showed statistically significant differences related to PPFS (HR 1.035, 95%CI: 1.012-1.057) (p = 0.002) with a C-index of 0.670 (95%CI: 0.529-0.810) and AUC of 0.714 (95%CI: 0.603-0.825) at 5 years. In our series, the most reliable cut-off point for SelectMDx was 5, with a sensitivity and specificity for PP of 69.8% and 67.4%, respectively. Same figure for PCA3 was 65, with a sensitivity and specificity for PP of 51.16% and 74.42%, respectively. The combination of both biomarkers did not improve the prediction of PP, C-index 0.630 (95%CI: 0.455-0.805). CONCLUSIONS In the context of low or very low risk PCa, SelectMDx > 5 predicted 5 years PP free survival with a moderate discrimination ability outperforming PCA3. The combination of both tests did not improved outcomes.
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Affiliation(s)
- D Fiorella
- Departamento de Urología, Instituto Valenciano de Oncología, Valencia, Spain
| | - J L Marenco
- Departamento de Urología, Instituto Valenciano de Oncología, Valencia, Spain
| | - J M Mascarós
- Departamento de Urología, Instituto Valenciano de Oncología, Valencia, Spain
| | - Á Borque-Fernando
- Departamento de Urología, IIS-Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - L M Esteban
- Departamento de Matemáticas Aplicadas, Escuela Universitaria Politécnica de La Almunia, Universidad de Zaragoza, La Almuniade Doña Godina, Zaragoza, Spain
| | - A Calatrava
- Departamento de Patología, Instituto Valenciano de Oncología, Valencia, Spain
| | - B Pastor
- Laboratorio de Biología Molecular, Instituto Valenciano de Oncología, Valencia, Spain
| | - J A López-Guerrero
- Laboratorio de Biología Molecular, Instituto Valenciano de Oncología, Valencia, Spain; IVO-CIPF Joint Research Unit of Cancer, Centro de Investigación Príncipe Felipe (CIPF), Valencia, Spain; Departamento de Patología, Facultad de Medicina, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - J Rubio-Briones
- Departamento de Urología, Instituto Valenciano de Oncología, Valencia, Spain.
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Polo Alonso E, Ramírez-Backhaus M, Wei G, Mascarós JM, Aragón Rodriguez F, Gómez-Ferrer Á, Collado A, Calatrava Fons A, Rubio-Briones J. Does active surveillance avoid overtreatment in prostate cancer? Lessons learned from salvage radical prostatectomies. Actas Urol Esp 2021; 45:373-382. [PMID: 34088437 DOI: 10.1016/j.acuroe.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Determine whether our institution´s active surveillance (AS) protocol is a suitable strategy to minimise prostate cancer overtreatment. MATERIAL AND METHODS Retrospective analysis of 516 patients on AS after prostate cancer diagnosis. Population divided into "per-protocol" vs "induced" AS depending on fulfilment of protocol´s inclusion criteria. Radical prostatectomies after AS were selected and stratified based on: reclassification, progression or patient anxiety. Clinicopathological features and biochemical relapse-free survival were studied. Primary endpoint was overtreatment ratio based on the presence of insignificant prostate cancer and adverse pathological features in the surgical specimen. Kaplan-Meier curves were used to estimate the biochemical relapse-free survival and compared with log-rank test. RESULTS 304 patients fulfilled inclusion criteria; 100 proceeded to radical prostatectomy (31% "induced", 69% "per-protocol" AS). Surgery indications were reclassification, progression and anxiety in 66%, 18% and 16% of patients respectively. Rate of positive lymph nodes was higher in the progression group (11%) compared to reclassification and anxiety (5% and 0% respectively, P = .002). Positive surgical margins were more frequently reported in the progression cohort compared to reclassification (28% vs 20%). Median follow-up from diagnosis until last radical prostatectomy was 48.3 months (32.4-70). 3 year biochemical relapse-free survival in the salvage radical prostatectomy was 85.4% (95 CI 78.3-93.2). Insignificant cancer was noticed in 7% of patients (Epstein´s vs 24% Wolters´ criteria). Rate of patients with adverse pathological features was 36%. CONCLUSIONS The majority of patients who underwent salvage surgery after AS were not overtreated. Radical prostatectomy should be considered a safe rescue treatment.
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Affiliation(s)
- E Polo Alonso
- Departamento de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
| | - M Ramírez-Backhaus
- Departamento de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - G Wei
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia; Young Urology Researchers Organisation (YURO), Melbourne, Victoria, Australia
| | - J M Mascarós
- Departamento de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - F Aragón Rodriguez
- Departamento de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Á Gómez-Ferrer
- Departamento de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - A Collado
- Departamento de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - A Calatrava Fons
- Departamento de Patología, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - J Rubio-Briones
- Departamento de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
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Rubio-Briones J, Borque-Fernando A, Esteban LM, Mascarós JM, Ramírez-Backhaus M, Casanova J, Collado A, Mir C, Gómez-Ferrer A, Wong A, Aragón F, Calatrava A, López-Guerrero JA, Groskopf J, Schalken J, Van Criekinge W, Domínguez-Escrig J. Validation of a 2-gene mRNA urine test for the detection of ≥GG2 prostate cancer in an opportunistic screening population. Prostate 2020; 80:500-507. [PMID: 32077525 DOI: 10.1002/pros.23964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/31/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND A 2-gene urine-based molecular test that targets messenger RNAs known to be overexpressed in aggressive prostate cancer (PCa) has been described as a helpful method for detecting clinically significant prostate cancer (grade group [GG] ≥2). We performed an external validation of this test in men undergoing initial prostate biopsy (Bx) within a Spanish opportunistic screening scenario. METHODS We analyzed archived samples from 492 men who underwent prostate Bx in an opportunistic screening scenario, with prostate-specific antigen (PSA) 3 to 10 ng/mL and/or suspicious digital rectal exploration (DRE) and without previous multi-parametric magnetic resonance imaging (mpMRI). Urinary biomarker measurements were combined with clinical risk factors to determine a risk score, and accuracy for GG ≥ 2 PCa detection was compared with PCA3, European randomized screening in prostate cancer (ERSPC), and prostate biopsy collaborative group (PBCG) risk calculators in a validation workup that included calibration, discrimination, and clinical utility analysis. RESULTS In our cohort, the detection rates for GG1 and GG ≥ 2 PCa were 20.3% and 14.0%, respectively. The median PSA level was 3.9 ng/mL and 13.4% of subjects had suspicious DRE findings. The median risk score for men with GG ≥ 2 PCa was 21 (interquartile range: 14-28), significantly higher than benign+GG1 PCa (10, 6-18), P < .001, achieving the highest area under the curve among the models tested, 0.749 (95% confidence interval: 0.690-0.807). The urine test was well-calibrated, while ERSPC showed a slight underestimation and PBCG a slight overestimation of risk. Assuming a GG2 non-detection rate of 11% without using mpMRI, use of the urinary biomarker-based clinical model could have helped avoid 37.2% of excess biopsies while delaying the diagnosis of eight patients (1.6% of the entire cohort) with GG ≥ 2 PCa. CONCLUSIONS In this first evaluation in an opportunistic screening population, the urinary biomarker-based test improved the detection of clinically significant PCa. Facing men with elevated PSA and/or suspicious DRE, it could be a useful tool to help avoid excess initial Bx and to identify patients most likely to benefit from Bx.
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Affiliation(s)
- Jose Rubio-Briones
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Angel Borque-Fernando
- Department of Urology, IIS-Aragón, University Hospital Miguel Servet, Zaragoza, Spain
| | - Luis M Esteban
- Department of Applied Mathematics, Universitary Politecnic School of La Almunia, University of Zaragoza, Zaragoza, Spain
| | - Juan M Mascarós
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Juan Casanova
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Argimiro Collado
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Carmen Mir
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Augusto Wong
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Fuensanta Aragón
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Ana Calatrava
- Department of Pathology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Jose A López-Guerrero
- Department of Urology, Molecular Biology Laboratory, Instituto Valenciano de Oncología, Valencia, Spain
| | - Jack Groskopf
- Department of Research in Biomarkers, MDxHealth, Irvine, California
| | - Jack Schalken
- Department of Experimental Urology, Radboud University, Nijmegen, The Netherlands
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