Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice
Abstract
:1. Introduction
2. Evidence Acquisition
3. Evidence Synthesis
3.1. Blood Biomarkers
- ○
- PSA
- ○
- PSA kinetics
- ○
- PSA density (PSAD)
- ○
- Prostate Health Index (PHI)
- ○
- 4Kscore®
3.2. Tissue Biomarkers
- ○
- Oncotype DX® Genomic Prostate Score (GPS)
- ○
- Genome DX Decipher® Genomic Classifier
- ○
- Prolaris® (Cell Cycle Progression Score)
3.3. Urine Biomarkers
- ○
- Prostate Cancer Antigen 3 (PCA3)
- ○
- TMPRSS2:ERG (T2E) fusion gene
- ○
- SelectMDx
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AA | African American |
AP | adverse surgical pathology |
AS | active surveillance |
AUC | area under the curve |
BR | biochemical recurrence |
CAPRA | Cancer of the Prostate Risk Assessment |
CCP | Cell Cycle Progression |
CCR | cell cycle risk |
C-index | concordance-index |
CsPCa | clinically significant prostate cancer |
DLX1 | distal-less homeobox 1 |
DRE | digital rectal examination |
ESMO | European Society of Medical Oncology |
FDA | Food and Drug Administration |
FFPE | formalin-fixed paraffin-embedded |
fPSA | free PSA |
GPS | Genomic Prostate Score |
GS | Gleason score |
HOXC6 | urinary homeobox C6 |
HRL | high-risk localised |
iPSA | intact PSA |
IRL | intermediate-risk localised |
ISUP | International Society of Urological Pathology |
ln(PSA) | logarithm of PSA |
LRL | low-risk localised |
M1 | metastatic |
MiPS | MiProstate Score |
mpMRI | multiparametric magnetic resonance imaging |
N+ | nodal positive |
NCCN | National Comprehensive Cancer Network |
PASS | Canary Prostate Active Surveillance Study |
PCa | prostate cancer |
PCA3 | prostate cancer antigen 3 |
PCPTRC | Prostate Cancer Prevention Trial risk calculator |
PHI | Prostate Health Index |
PSA | prostate-specific antigen |
PSAD | prostate-specific antigen density |
PSADT | prostate-specific antigen doubling-time |
PSAk | prostate-specific antigen kinetics |
PSAV | prostate-specific antigen velocity |
PSAV RC | PSAV Risk Count |
RT-qPCR | real-time quantitative polymerase chain reaction |
T2E | TMPRSS2:ERG |
TDRD1 | tudor domain containing 1 |
tPSA | total PSA |
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Biomarker | Source | Characteristics | AS Application | References |
---|---|---|---|---|
PSA | Blood | PSA is a glycoprotein secreted by prostatic epithelial cells that lyses the clotted ejaculate to enhance sperm motility. It is the most important commonly used biomarker, but it has been shown not to be a cancer-specific marker, as some prostate diseases could also produce PSA elevated levels | Its role as biomarker in AS has been questioned due to its variability and has been mostly studied related to its changes with time, prostate volume or other isoforms | [19] |
PSA kinetics | Blood | Rate of PSA change over time: PSA doubling time (PSADT) is the number of years over which a certain level of PSA increases by a factor of two and is calculated as DT = ln(2); PSA velocity (PSAV) represents a change in PSA level over time/m | Differentiates between PCa with more and less aggressive natural history | [20,21,22,23,24,25] |
PSA density (PSAD) | Blood | Dividing preoperative PSA by prostate weight without seminal vesicles | Predicts upgrading and reclassification in men with low-risk PCa enrolled in AS, by improving the inclusion criteria and follow-up of PCa patients | [26,27,28,29] |
Prostate Health Index (PHI) | Blood | Index calculated as [-2]proPSA/fPSA x √PSA | PHI measurement could be clinically useful in discriminating the presence of insignificant PCa in active surveillance candidates | [30,31,32,33,34,35] |
4Kscore® | Blood | A panel of four kallikreins (tPSA, fPSA, intact PSA [iPSA], and human kallikrein 2 [hK2]) combined with clinical data available before cancer diagnosis | Identifies patients most likely to benefit from biopsy because of a high risk of having a clinically significant tumour that would require active treatment | [36,37,38,39,40,41] |
Oncotype DX® Genomic Prostate Score (GPS) | Tissue | RNA based expression assay of 12 PCa related normalized to 5 housekeeping genes | Associated with an increased risk of AP and BR in the initial test of early-stage PCa | [42,43,44,45,46,47,48,49,50] |
Genome DX Decipher® Genomic Classifier | Tissue | Includes 22 coding and non-coding genes, which covers seven cancer pathways, such as angiogenesis, invasion and metastasis, or growth and differentiation | Helps to predict metastasis risk after RP and exclude patients of following AS programs | [51,52,53,54,55,56] |
Prolaris® (Cell Cycle Progression Score) | Tissue | RNA expression signature based on measuring the expression levels of 31 genes that participate in cell cycle progression and 15 housekeeping genes | Helps to identify patients who may warrant increased intervention intensity due to their predicted risk of metastatic disease | [57,58,59,60,61] |
Prostate Cancer Antigen 3 (PCA3) | Urine | Non-coding mRNA only expressed in human prostate tissue but overexpressed in PCa tissue | Patients who reclassified had significantly higher PCA3 scores at both initial and subsequent measures, indicating an association with grade reclassification | [62,63,64,65,66,67] |
TMPRSS2:ERG fusion gene | Urine | T2E fusion gene is present in approximately 50% of prostatic tumours and is detected both in FFPE and urine samples | Non-invasive T2E measurement in urine may refine patient acceptance into AS programs | [68,69,70,71,72,73,74,75,76,77] |
SelectMDx | Urine | Combines serum PSA, PSAD and clinical factors such as age and prior negative biopsy with mRNA signatures: urinary homeobox C6 (HOXC6) and distal-less homeobox 1 (DLX1) | Can detect high-grade csPCa accurately and could therefore be used in AS decision making, reducing the number of unnecessary prostate biopsies and potential overtreatment | [78,79,80,81,82,83,84,85] |
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Pastor-Navarro, B.; Rubio-Briones, J.; Borque-Fernando, Á.; Esteban, L.M.; Dominguez-Escrig, J.L.; López-Guerrero, J.A. Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice. Int. J. Mol. Sci. 2021, 22, 6266. https://doi.org/10.3390/ijms22126266
Pastor-Navarro B, Rubio-Briones J, Borque-Fernando Á, Esteban LM, Dominguez-Escrig JL, López-Guerrero JA. Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice. International Journal of Molecular Sciences. 2021; 22(12):6266. https://doi.org/10.3390/ijms22126266
Chicago/Turabian StylePastor-Navarro, Belén, José Rubio-Briones, Ángel Borque-Fernando, Luis M. Esteban, Jose Luis Dominguez-Escrig, and José Antonio López-Guerrero. 2021. "Active Surveillance in Prostate Cancer: Role of Available Biomarkers in Daily Practice" International Journal of Molecular Sciences 22, no. 12: 6266. https://doi.org/10.3390/ijms22126266