Abstract
Multiparametric MRI (mpMRI) and targeted biopsy of the prostate enhance the tumor detection rate. However, the prediction of clinically significant prostate cancer (PCa) is still limited. Our study tested the additional value of serum levels of selected miRNAs in combination with clinical and mpMRI information for PCa prediction and classification. A total of 289 patients underwent targeted mpMRI-ultrasound fusion-guided prostate biopsy complemented by systematic biopsy. Serum miRNA levels of miRNAs (miR-141, miR-375, miR-21-5p, miR-320b, miR-210-3p, let-7c, and miR-486) were determined by quantitative PCR. Detection of any PCa and of significant PCa were the outcome variables. The patient age, pre-biopsy PSA level, previous biopsy procedure, PI-RADS score, and serum miRNA levels were covariates for regularized binary logistic regression models. The addition of miRNA expression of miR-486 and let-7c to the baseline model, containing only clinical parameters, increased the predictive accuracy. Particularly in patients with PI-RADS ≤3, we determined a sensitivity for detecting significant PCa (Gleason score ≥ 7a corresponding to Grade group ≥2) of 95.2%, and an NPV for absence of significant PCa of 97.1%. This accuracy could be useful to support patient counseling in selected cases.
Highlights
Multiparametric magnetic resonance imaging and targeted biopsy of tumorsuspicious lesions have become established diagnostic tools for the detection of prostate cancer (PCa) [1], since ultrasound-guided biopsy alone misses approximately 25–30% of PCa cases [2,3]
In patients with Prostate Imaging Reporting and Data System (PI-RADS) ≤3, we determined a sensitivity for detecting significant PCa (Gleason score ≥ 7a corresponding to Grade group ≥2) of 95.2%, and an NPV for absence of significant PCa of 97.1%
We and others could demonstrate that miRNAs derived from whole blood [10] or blood serum [11,12,13,14] can serve as biomarkers with the potential to differentiate PCa patients from patients with benign prostatic hyperplasia
Summary
Multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy of tumorsuspicious lesions have become established diagnostic tools for the detection of prostate cancer (PCa) [1], since ultrasound-guided biopsy alone misses approximately 25–30% of PCa cases [2,3]. An increasing amount of published data has shown that targeted MRI-ultrasound fusion-guided biopsies have the potential to reduce the diagnosis of insignificant PCa and to enhance the detection rate of clinically significant PCa while reducing the number of biopsies, as the Prostate Imaging Reporting and Data System (PI-RADS) has a good diagnostic accuracy and correlation with PCa aggressiveness [6,7]. Clinical parameters, such as the pre-biopsy serum PSA level and mpMRI of the prostate, represent the basis of the clinical information used for decision making and patient counseling.
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