Investigating Efficient Risk-Stratified Pathways for the Early Detection of Clinically Significant Prostate Cancer
Morote Robles, Juan (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Borque-Fernando, Ángel (Hospital Universitario Miguel Servet (Saragossa))
Esteban, Luis M (Universidad de Zaragoza)
Celma, Ana (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Campistol, Miriam (Hospital Universitari Vall d'Hebron)
Miró, Berta (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Méndez Fernández, Olga (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Trilla Herrera, Enrique (Universitat Autònoma de Barcelona. Departament de Cirurgia)

Data:	2024
Resum:	Risk-stratified pathways (RSPs) are recommended by the European Association of Uro-logy (EAU) to improve the early detection of clinically significant prostate cancer (csPCa). RSPs can reduce magnetic resonance imaging (MRI) demand, prostate biopsies, and the over-detection of insignificant PCa (iPCa). Our goal is to analyze the efficacy and cost-effectiveness of several RSPs by using sequential stratifications from the serum prostate-specific antigen level and digital rectal examination, the Barcelona risk calculators (BCN-RCs), MRI, and Proclarix™. In a cohort of 567 men with a serum PSA level above 3. 0 ng/mL who underwent multiparametric MRI (mpMRI) and targeted and/or systematic biopsies, the risk of csPCa was retrospectively assessed using Proclarix™ and BCN-RCs 1 and 2. Six RSPs were compared with those recommended by the EAU that, stratifying men from MRI, avoided 16. 7% of prostate biopsies with a prostate imaging-reporting and data system score of <3, with 2. 6% of csPCa cases remaining undetected. The most effective RSP avoided mpMRI exams in men with a serum PSA level of >10 ng/mL and suspicious DRE, following stratifications from BCN-RC 1, mpMRI, and Proclarix™. The demand for mpMRI decreased by 19. 9%, prostate biopsies by 19. 8%, and over-detection of iPCa by 22. 7%, while 2. 6% of csPCa remained undetected as in the recommended RSP. Cost-effectiveness remained when the Proclarix™ price was assumed to be below EUR 200.
Ajuts:	Instituto de Salud Carlos III PI20/01666
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Screening ; Prostate cancer ; Barcelona risk calculator ; Proclarix ; Risk-stratified pathway
Publicat a:	Journal of personalized medicine, Vol. 14, Núm. 2 (January 2024) , ISSN 2075-4426

DOI: 10.3390/jpm14020130
PMID: 38392564

15 p, 3.0 MB

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