Prostate Extracellular Vesicles and Prognostic Biomarkers of Clinically Significant Prostate Cancer: A Prospective...

Area of Science:

• Urology
• Oncology
• Biomarker Discovery

Background:

• Multiparametric MRI (mpMRI) and commercial biomarkers aid in triaging men with elevated prostate-specific antigen (PSA).
• Accurate prediction of clinically-significant prostate cancer (csPCa) is crucial for appropriate patient management.
• Novel extracellular vesicle (EV)-based biomarkers offer potential for improved prostate cancer detection.

Purpose of the Study:

• To evaluate the optimal combination of mpMRI, PSA-based, and EV-based biomarkers for predicting csPCa.
• To determine the most effective pre-biopsy testing strategy for identifying csPCa.
• To assess the added value of EV biomarkers in combination with existing methods.

Main Methods:

• Prospective enrollment of 175 men with elevated PSA (≥2 ng/mL).
• All participants underwent mpMRI and provided blood samples for PSA, prostate health index (PHI), and EV serum level analysis.
• MRI-fusion transperineal prostate biopsy was performed, with sensitivity, specificity, PPV, and NPV calculated via ROC curves and bootstrapping.

Main Results:

• Combinations of biomarkers and MRI outperformed individual modalities in predicting csPCa.
• Prostate health index density (PHID)-mpMRI achieved the highest predictive ability with an AUC of 0.86.
• PSA density-mpMRI (AUC: 0.81) and STEAP1-mpMRI (AUC: 0.77) also showed significant predictive capabilities.

Conclusions:

• Integrating prostate density with biomarkers enhances the prognostic ability for detecting csPCa.
• Extracellular vesicle (EV) density refines csPCa prediction, especially when combined with PHID-mpMRI.
• This combined approach offers superior specificity, potentially reducing the rate of unnecessary prostate biopsies.