Magnetic Resonance Imaging and Biomarkers for Early Prostate Cancer Diagnosis in High-Risk Men

What is it about?

The study evaluated the management of early diagnosis of cancer in men at high genetic risk using recently developed blood and urinary molecular biomarkers in combination with clinical information and multiparametric magnetic resonance imaging (mpMRI). A total of 322 patients with a high genetic risk were included in the study, and the primary outcome was the detection rates of prostate cancer (positive biopsy) or clinically significant prostate cancer (biopsy with International Society of Urological Pathology [ISUP] grade >1). The results showed that screening men at high genetic risk for prostate cancer must be based on mpMRI without pre-screening based on a PSA level of >3 ng/mL to avoid missing too many ISUP grade >1 tumors and significantly reduce the number of unnecessary biopsies. However, urinary markers or a PSAD of ≥0.10 ng/mL/mL when mpMRI was negative increased the detection of ISUP grade >1 cancers. The study suggested that a baseline mpMRI be discussed for men at high genetic risk from the age of 40 years.

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Why is it important?

The research is important as it evaluates different scenarios for the management of early diagnosis of cancer (PCa) in men at high genetic risk using recently developed blood and urinary molecular biomarkers in combination with clinical information alongside multiparametric magnetic resonance imaging (mpMRI). This study provides valuable insights into the most effective diagnostic methods for men at high genetic risk, which can help in early detection and improved outcomes. Key Takeaways: 1. A total of 322 patients with a high genetic risk were included in the study. 2. The primary outcome was the detection rates of PCa (positive biopsy) or clinically significant PCa (biopsy with International Society of Urological Pathology [ISUP] grade >1). 3. mpMRI Prostate Imaging-Reporting and Data System (PI-RADS) score ≥3 showed higher sensitivity (Se) than mpMRI PI-RADS score ≥4 for detection of PCa (82% vs 61%) and for the detection of ISUP grade >1 lesions (96% vs 80%). 4. mpMRI PI-RADS score ≥3 performed better than a PSA level of ≥3 ng/mL for detection of clinically significant PCa. 5. In case of negative mpMRI results, the supervised Bayesian network approach showed that urinary markers (with the same accuracy for all) and PSAD of ≥0.10 ng/mL/mL were the most useful indicators of decision to biopsy. 6. Screening men at high genetic risk of PCa must be based on mpMRI without pre-screening based on a PSA level of >3 ng/mL, to avoid missing too many ISUP grade >1 tumours and to significantly reduce the number of unnecessary biopsies. 7. A baseline mpMRI should be offered to high-risk carriers at the age of 40 years.