Evaluation of the Predictive Role of Blood-Based Biomarkers in the Context of Suspicious Prostate MRI in Patients Undergoing Prostate Biopsy.

Paweł Rajwa ,Fahad Quhal,Stephan Korn,Andrzej Paradysz,Piotr Bryniarski,Frederik König,Hadi Mostafaei,Keiichiro Mori,Takafumi Yanagisawa,Reza Sari Motlagh,Abdulmajeed Aydh,Nico C Grossmann,Victor M Schuettfort,Shahrokh F Shariat,Bernhard Grubmüller,Ekaterina Laukhtina,Benjamin Pradère ,Nicolai Huebner ,Pascal Baltzer ,Dadjar Immanuel Hostermann

doi:10.3390/jpm11111231

Abstract

The aim of this study was to assess the predictive value of pre-biopsy blood-based markers in patients undergoing a fusion biopsy for suspicious prostate magnetic resonance imaging (MRI). We identified 365 consecutive patients who underwent MRI-targeted and systematic prostate biopsy for an MRI scored Prostate Imaging–Reporting and Data System Version (PI-RADS) ≥ 3. We evaluated the neutrophil/lymphocyte ratio (NLR), derived neutrophil/lymphocyte ratio (dNLR), platelet/lymphocyte ratio (PLR), systemic immune inflammation index (SII), lymphocyte/monocyte ratio (LMR,) de Ritis ratio, modified Glasgow Prognostic Score (mGPS), and prognostic nutrition index (PNI). Uni- and multivariable logistic models were used to analyze the association of the biomarkers with biopsy findings. The clinical benefits of biomarkers implemented in clinical decision-making were assessed using decision curve analysis (DCA). In total, 69% and 58% of patients were diagnosed with any prostate cancer and Gleason Grade (GG) ≥ 2, respectively. On multivariable analysis, only high dNLR (odds ratio (OR) 2.61, 95% confidence interval (CI) 1.23–5.56, p = 0.02) and low PNI (OR 0.48, 95% CI 0.26–0.88, p = 0.02) remained independent predictors for GG ≥ 2. The logistic regression models with biomarkers reached AUCs of 0.824–0.849 for GG ≥ 2. The addition of dNLR and PNI did not enhance the net benefit of a standard clinical model. Finally, we created the nomogram that may help guide biopsy avoidance in patients with suspicious MRI. In patients with PI-RADS ≥ 3 lesions undergoing MRI-targeted and systematic biopsy, a high dNLR and low PNI were associated with unfavorable biopsy outcomes. Pre-biopsy blood-based biomarkers did not, however, significantly improve the discriminatory power and failed to add a clinical benefit beyond standard clinical factors.

Highlights

Over the last decade, magnetic resonance imaging (MRI) has become an essential tool for the diagnosis and management of prostate cancer (PCa) [1,2]
The fully MRI-guided PCa diagnostic pathway is hampered by the poor positive predictive value of suspicious MRI, which leads to unnecessary biopsies and, despite the strong negative predictive value, a 10–20% risk of missing significant PCa
Our results suggest that approximately 50% of patients with suspicious MRI do not have significant cancer on biopsy; the probability was highest for patients with Prostate Imaging–Reporting and Data System Version (PI-RADS) 3 lesions (84%)

Summary

Introduction

Magnetic resonance imaging (MRI) has become an essential tool for the diagnosis and management of prostate cancer (PCa) [1,2]. MRI allows visualization and assessment of the extent of suspicious lesions, in addition to guiding targeted biopsies [3,4,5]. This strategy has led to a higher likelihood of detecting clinically significant PCa (International Society of Urological Pathology (ISUP) Gleason. Major urological guidelines recommend performing MRI-targeted and systematic biopsy in patients with a PI-RADS ≥ 3 lesion [1,6]. The PI-RADS classification limits the intrareader variability and allows, with approximately 80% accuracy, to exclude clinically significant PCa, the overall predictive value remains low to moderate

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