Lanzotti Nicholas J, Du Chris, Hall Julia, Saba Joseph, Picken Maria M, Gupta Gopal N
Department of Urology, Loyola University Medical Center, Maywood, IL 60153, USA.
Stritch School of Medicine, Loyola University, Maywood, IL 60153, USA.
J Pers Med. 2025 Jul 1;15(7):279. doi: 10.3390/jpm15070279.
The multigene molecular testing of prostate cancer tissue after biopsy provides individualized information to guide further management. The utility of selective genetic testing for MRI-visible target versus systematic cancer in patients as well as during different time points of active surveillance (AS) is unknown. The objective of this study was to compare Prolaris results of MRI-target cancers versus systematic cancers on prostate needle biopsy as well as both during consideration for initial AS candidacy and candidacy for remaining on AS. Our prospectively maintained institutional multiparametric (mp) MRI prostate cancer active surveillance database (2013-2024) was queried for patients that underwent Prolaris genetic testing of positive biopsy cores. Baseline information for PSA, PSA density, and Prolaris calculated data were collected. Information on the timing of the Prolaris testing, defined as during the initial cancer diagnostic biopsy or on a subsequent confirmatory biopsy was collected. SPSS v29.0 was used to compare the selective Prolaris results of MRI-target cancers versus systematic cancers during different points of AS. 264 patients with a Prolaris test were identified, 86 with MRI-target and 178 on systematic cancers. 182 Prolaris tests were sent on a diagnostic biopsy and 81 on a subsequent biopsy. Overall, MRI-target cancers had similar risk scores (3.23 vs. 3.14, 0.18). Prolaris scores were higher for GG2 systematic than GG1 target cancers (3.40 vs. 3.18, 0.023). The GG2 systematic lesion cohort also had higher predicted the 10-year disease-specific mortality (DSM) (3.40% vs. 2.30%, 0.01) and 10-year metastasis risk (1.90% vs. 1.20%, 0.013), and more aggressive recommended treatment. Analyses of the Prolaris results sent during a diagnostic biopsy yielded similar results. Finally, on an analysis of the Prolaris results sent during subsequent biopsy, a systematic GG2 biopsy was noted to have a higher 10-year DSM and metastasis rate, but similar risk scores and treatment recommendations. Prolaris tests can be sent at multiple time points of AS, and selectively for MRI-visible versus higher grade cancers. There is no consistent association between MRI-visible cancer and Prolaris risk profile. When utilizing multigene molecular testing in prostate cancer, each individual patient must be evaluated to decide the appropriate level of care.
活检后对前列腺癌组织进行多基因分子检测可提供个性化信息，以指导进一步的治疗管理。对于患者中MRI可见靶点肿瘤与系统性肿瘤，以及在主动监测（AS）的不同时间点进行选择性基因检测的效用尚不清楚。本研究的目的是比较前列腺穿刺活检时MRI靶点肿瘤与系统性肿瘤的Prolaris检测结果，以及在考虑初始AS候选资格和继续进行AS的候选资格时的检测结果。我们前瞻性维护的机构多参数（mp）MRI前列腺癌主动监测数据库（2013 - 2024年）被查询，以获取对阳性活检核心进行Prolaris基因检测的患者信息。收集了PSA、PSA密度的基线信息以及Prolaris计算数据。收集了Prolaris检测时间的信息，定义为在初始癌症诊断活检期间或后续确认活检时。使用SPSS v29.0比较AS不同阶段MRI靶点肿瘤与系统性肿瘤的选择性Prolaris检测结果。确定了264例进行Prolaris检测的患者，其中86例为MRI靶点肿瘤，178例为系统性肿瘤。182次Prolaris检测在诊断活检时进行，81次在后续活检时进行。总体而言，MRI靶点肿瘤的风险评分相似（3.23对3.14，P = 0.18）。GG2级系统性肿瘤的Prolaris评分高于GG1级靶点肿瘤（3.40对3.18，P = 0.023）。GG2级系统性病变队列的10年疾病特异性死亡率（DSM）预测也更高（3.40%对2.30%，P = 0.01），10年转移风险更高（1.90%对1.20%，P = 0.013），且推荐的治疗更积极。对诊断活检时发送的Prolaris结果进行分析得出了类似结果。最后，对后续活检时发送的Prolaris结果进行分析时，发现系统性GG2活检的10年DSM和转移率更高，但风险评分和治疗建议相似。Prolaris检测可在AS的多个时间点进行，并且可针对MRI可见肿瘤与高级别肿瘤进行选择性检测。MRI可见肿瘤与Prolaris风险概况之间没有一致的关联。在前列腺癌中使用多基因分子检测时，必须对每个患者进行评估，以确定适当的治疗水平。
