Open Access

ARTICLE

Assessment of high-grade prostate cancer risk using prostate cancer biomarkers

Whitney N. Stanton¹, E. David Crawford², Paul B. Arangua³, Francisco G. La Rosa¹, Adrie van Bokhoven¹, M. Scott Lucia¹, Wendy L. Poage⁴, Alan Partin⁵, Paul Maroni³, Priya N. Werahera¹

1 Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
2 University of California San Diego, La Jolla, California, USA
3 Department of Urology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
4 Prostate Conditions Education Council, Centennial, Colorado, USA
5 Johns Hopkins Medicine, Baltimore, Maryland, USA
Address correspondence to Dr. Priya N. Werahera, Department of Pathology, University of Colorado Anschutz Medical Campus, Mail Stop 8104, PO Box 6511, Aurora, CO 80045 USA

Canadian Journal of Urology 2020, 27(1), 10080-10085.

Abstract

Introduction: To identify patients at risk of high-grade prostate cancer using prostate cancer biomarkers.
Materials and methods: A total of 601 men were screened for prostate cancer in 2012, 2015, and 2016 using prostate cancer biomarkers: prostate health index (phi), 4KScore, and SelectMDx. The first two are blood tests that incorporate several PSA isoforms; SelectMDx measures mRNA levels of homeobox C6 and distal-less homeobox 1 in post-digital rectal examination urine samples. The performance of each biomarker was evaluated using cut-off values based on published literature. Gleason Grade Group (GG) ≥ 2 is considered as high-grade prostate cancer.
Results: For patients with PSA < 1.5 ng/mL, none were at risk for GG ≥ 2 cancer based on SelectMDx > 0%, whereas 17.1% were at intermediate to high risk of finding GG ≥ 2 cancer with 4KScore ≥ 7.5%, and 3.5% were at risk of finding any prostate cancer with phi ≥ 36 at biopsy. For cut-offs revised for finding men at high risk for GG ≥ 2 cancer at biopsy, only one patient with PSA < 1.5 ng/mL would be at risk with 4KScore ≥ 20% and none with phi ≥ 52.7. For patients with PSA 1.5 to 3.99 ng/mL, 2%, 8%, and 1% were at high risk for finding GG ≥ 2 cancer at biopsy based on phi, 4KScore, and SelectMDx, respectively.
Conclusions: Men with PSA < 1.5 ng/mL are at very low risk of finding high-grade prostate cancer at biopsy. However, some men with PSA between 1.5 to 3.99 ng/mL may be at intermediate to high risk for high-grade prostate cancer. Thus, primary care physicians could run biomarker tests and refer those with positive biomarker results to a specialist for further evaluation.

---

Keywords

---