Imaging as a Personalized Biomarker for Prostate Cancer Risk Stratification.

Kyle Gennaro,Soroush Rais-Bahrami,Jennifer Gordetsky,Samuel Galgano,Kristin Porter

doi:10.3390/diagnostics8040080

Kyle Gennaro, Soroush Rais-Bahrami + Show 3 more

Open Access

https://doi.org/10.3390/diagnostics8040080

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Abstract

Biomarkers provide objective data to guide clinicians in disease management. Prostate-specific antigen serves as a biomarker for screening of prostate cancer but has come under scrutiny for detection of clinically indolent disease. Multiple imaging techniques demonstrate promising results for diagnosing, staging, and determining definitive management of prostate cancer. One such modality, multiparametric magnetic resonance imaging (mpMRI), detects more clinically significant disease while missing lower volume and clinically insignificant disease. It also provides valuable information regarding tumor characteristics such as location and extraprostatic extension to guide surgical planning. Information from mpMRI may also help patients avoid unnecessary biopsies in the future. It can also be incorporated into targeted biopsies as well as following patients on active surveillance. Other novel techniques have also been developed to detect metastatic disease with advantages over traditional computer tomography and magnetic resonance imaging, which primarily rely on defined size criteria. These new techniques take advantage of underlying biological changes in prostate cancer tissue to identify metastatic disease. The purpose of this review is to present literature on imaging as a personalized biomarker for prostate cancer risk stratification.

Highlights

IntroductionThe National Institutes of Health Biomarkers Definitions Working Group defines a biomarker as “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention” [1]
The National Institutes of Health Biomarkers Definitions Working Group defines a biomarker as “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention” [1].Historically, prostate-specific antigen (PSA) has been used as a biomarker for prostate cancer screening.PSA combined with physical exam findings, including a digital rectal exam (DRE), would indicate the need for further evaluation with a systematic biopsy [2]
Role of Multiparametric MRI in Prostate Cancer Diagnosis and Local Staging multiparametric magnetic resonance imaging (mpMRI) includes high-resolution T2-weighted sequences (T2), diffusion-weighted sequences (DWI), and dynamic contrast-enhanced images (DCE) [6]. mpMRI has demonstrated a great sensitivity in the detection of prostate cancer compared to standard techniques and correlates well with findings at final pathology [7,8]

Summary

Introduction

The National Institutes of Health Biomarkers Definitions Working Group defines a biomarker as “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention” [1]. PSA combined with physical exam findings, including a digital rectal exam (DRE), would indicate the need for further evaluation with a systematic biopsy [2]. The widespread adoption of PSA screening for prostate cancer in the 1990s led to a significant increase in the incidence of prostate cancer [3]. This increase in incidence is largely attributable to increased detection of low-risk disease that may not affect patient mortality.

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