Update and advances in prostate cancer screening and diagnoses

Prostate cancer screening was revolutionized in the early 1990s with the wide spread availability and FDA approval of PSA testing. PSA however is not specific for clinically significant prostate cancer and while PSA testing improves prostate cancer specific mortality worries regarding how wide-spread screening could lead to overdiagnosis and overtreatment emerged. Currently prostate cancer screening is not equated with PSA screening. Rather there is a tiered approach ideally utilizing more specific biomarkers and imaging prior to initial biopsy. Moreover, personalized screening strategies which may include genetics, family history and baseline biomarkers are emerging. This collection provides articles detailing recent updates and advances in prostate cancer screening and diagnosis.

Editors

Jun Luo ,

Jack Schalken ,

Ashely E. Ross &

Riccardo Autorino

Content

Evaluation of blood and urine based biomarkers for detection of clinically-significant prostate cancer

Hunter S. Robinson
Sangmyung S. Lee
Jeffrey J. Tosoian

Review Article10 Jun 2024 Prostate Cancer and Prostatic Diseases

Risk calculators for the detection of prostate cancer: a systematic review

Frederique B. Denijs
Meike J. van Harten
Monique J. Roobol

Article3 Jun 2024 Prostate Cancer and Prostatic Diseases

Concerns regarding prostate cancer screening guidelines in minority populations

Prostate-Specific Antigen (PSA) is a first-line recommended serum biomarker used for prostate cancer (PCa) screening. However, this test has critical limitations in specificity within the gray zone of PSA from 4–10 ng/ml. The low specificity for clinically significant Gleason grade group 2–5 (GG2-5) PCa leads to unnecessary negative biopsies, over-detection of indolent cancers, and over-treatment, especially in Black men with favorable risk PCa. The urological community relies on secondary screening tools to augment specificity and increase sensitivity for GG2-5 PCa such as multiparametric magnetic resonance imaging of the prostate (MRI). Current National Comprehensive Cancer Network (NCCN) Early Detection guidelines specifically call for biomarkers and MRI tests to improve the specificity of PSA. Urologists rely on the negative predictive value (NPV) of the secondary screening tools for GG2-5 PCa to defer biopsies for men with elevated PSA. However, the NPV of any threshold chosen decreases in populations with a high prevalence of GG2-5 PCa. For most of these popular secondary biomarkers, specificity and NPV have not been assessed in Black men despite their known high risk. It is necessary to focus on other aspects of accuracy like specificity, NPV and the correlation of predicted risk versus observed risk (i.e., calibration) in populations with both high and low PCa risk (e.g., Black and Asian men). The impact of the new NCCN guideline-supported PSA ≥ 3.0 ng/ml threshold and the currently recommended thresholds of the secondary screening tools should be modeled or prospectively evaluated to see if they provide an acceptable risk-benefit ratio. Beyond discrimination/area under the curve, biomarkers should be evaluated for their calibration, specificity at high sensitivity, and their NPV for men with varied prevalence of GG2-5 PCa before being told to forego prostate biopsy. Clinical, biomarker, and imaging-integrated race stratified risk calculators and statistical modeling can be used to improve screening outcomes in minorities. Guidelines should also involve community providers to better reflect the resource limited settings within the US.

Jamila Sweis
Bernice Ofori
Adam B. Murphy

Editorial19 Dec 2023 Prostate Cancer and Prostatic Diseases

Novel non-MRI imaging techniques for primary diagnosis of prostate cancer: micro-ultrasound, contrast-enhanced ultrasound, elastography, multiparametric ultrasound, and PSMA PET/CT

Francesco Ditonno
Antonio Franco
Riccardo Autorino

Review Article5 Aug 2023 Prostate Cancer and Prostatic Diseases

Optimizing detection of clinically significant prostate cancer through nomograms incorporating mri, clinical features, and advanced serum biomarkers in biopsy naïve men

Mohammad R. Siddiqui
Eric V. Li
Ashley E. Ross

Article27 Mar 2023 Prostate Cancer and Prostatic Diseases

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