Good PSA/MRI active surveillance results still require fusion biopsy?

A good urologist should work shared decision making, especially when one is in the "low risk" PCa stage.

Did you obtain a Decipher Score from your first biopsy? That report, especially the accompanying Decipher GRID report, was extremely informative and a decision confirmer for my case.

If not, you may want to ask your doc if he can have that done with the 3+3 core taken from your 1st biopsy....assuming there was even enough cancer to test...in your case....

handera-
After the "Prostate Biopsy Report" that included a 12-section grid and related report, my urologist preferred a "Genomic Prostate Score (GPS) Report" to the Decipher Test.
The 2pp GPS report was provided by mdxhealth.
My urologist summarized the GPS results as "low grade, low stage, low volume prostate Cancer, low GPS Oncotype Score" and made the AS decision based on that.
GPS result = 18, with likelihood of adverse pathology at RP = 19%.

I definitely plan to ensure more decision-making engagement on my part!

@handera You might want to ask your doctor about the PSE test which became available in the US in 2023. It takes a PSA test with 57% accuracy to 94-97% accuracy as it checks 5 genomic biomarkers with its blood test. Here is a link to a Urology times article. I would also use your biopsy material, if it is not too old, to take a Decipher test to check aggressiveness of the 3+3.
https://www.urologytimes.com/view/episwitch-prostate-screening-blood-test-launches-on-us-market

Thanks for the heads up!

Just for kicks I asked https://www.perplexity.ai the following question and within seconds received an amazingly comprehensive answer based on 8 high quality references listed below.
If anyone is wondering about the impact of AI in the field of PCa…look no further! AI's value in reducing one's research time to obtain high quality answers regarding complex subjects in almost all fields is absolutely incredible!

Q: How does the accuracy of the PSE test compare to the MPS2 test?

A: Based on the available information, we can compare the accuracy of the EpiSwitch Prostate Screening (PSE) Test and the MyProstateScore 2.0 (MPS2) test as follows:

Accuracy Comparison

EpiSwitch PSE Test
• Improves predictive accuracy from 55% (PSA alone) to 94%.
• Shows a specificity of 97% and sensitivity of 86%.

MyProstateScore 2.0 (MPS2) Test
• Demonstrates a sensitivity of 95% for Grade Group 2 (GG2) prostate cancers.
• Shows a sensitivity of 99% for cancers that were Grade Group 3 (GG3) or higher.
• Has negative predictive values of 95% to 99% for cancers of GG2 or greater, and 99% for cancers of GG3 or greater.

Performance Metrics

Area Under the Receiver Operating Characteristic (AUC) Curve
• MPS2: 0.81
• MPS2+ (including prostate volume): 0.82.

These values are significantly higher than other tests mentioned in the study:
• PSA alone: 0.60
• Prostate Cancer Prevention Trial risk calculator: 0.66
• Prostate Health Index (PHI): 0.77
• Original MPS model: 0.74.

Reduction in Unnecessary Biopsies

The MPS2 test shows potential to reduce unnecessary biopsies:
• 35% to 42% reduction in the initial biopsy population
• 46% to 51% reduction in the repeat biopsy population.

While both tests show impressive accuracy, the MPS2 test appears to have slightly higher sensitivity, especially for higher-grade cancers. However, it's important to note that these tests were not directly compared in the same study, so a definitive comparison is challenging. The MPS2 test seems to have more detailed performance data available in the provided search results, including its ability to reduce unnecessary biopsies. Both tests represent significant improvements over PSA testing alone and could potentially help reduce unnecessary biopsies while maintaining high sensitivity for detecting clinically significant prostate cancers.

References cited in perplexity AI’s answer:
https://www.health.harvard.edu/blog/new-urine-test-may-help-some-men-with-elevated-psa-avoid-biopsy-202405063038
https://www.nih.gov/news-events/nih-research-matters/urine-test-identifies-high-risk-prostate-cancers
https://prevention.cancer.gov/news-and-events/blog/improved-prostate-cancer-biomarker-test-may-help-men-avoid-unnecessary-biopsy
https://jamanetwork.com/journals/jamaoncology/fullarticle/2817657
https://pmc.ncbi.nlm.nih.gov/articles/PMC11190811/
https://news.vumc.org/2024/04/18/new-urine-test-has-higher-diagnostic-accuracy-for-prostate-cancer/
https://www.lynxdx.com/2024/04/news/mps2-clinically-validated-jama-oncology/
https://cancerworld.net/new-prostate-cancer-blood-test-psa-epigenetic/

And then there is the Artera.ai test, where you send images of your biopsy and they give you a lot of information about future treatment. The test takes 2 to 3 days to get results. It has been approved by the NCCN. This goes past the decipher test in the information that is supplied.

From Artera
The ArteraAI Prostate Test offers prognostic and predictive insights. The prognostic information includes a score indicating various risks for you, like metastasis (cancer spreading) and survival, while predictive information informs whether you are likely to benefit from a specific therapy, e.g., a hormone therapy or androgen deprivation therapy (ADT).

@handera Interesting ai response. I wonder if they have had any success with detecting biological re-occurrence?

@jeffmarc That looks promising. I love all these new tests that are a step before the biopsy. I have the same question for the Artera AI test as the MPS2 test. Can you use it for biological re-occurrence?

I don’t know the answer to that, but I would contact them to get more information..

@jeffmarc
I just contacted them and got a quick answer regarding the MPS2 test. They said:

"MPS 2.0 does not identify the biological recurrence of prostate cancer.

MPS 2.0 is a non-invasive urine test that analyzes 18 unique biomarkers and accurately quantifies the personalized risk of clinically significant prostate cancer (csPCa) for men with elevated PSA or abnormal DRE findings. The test results offer you and your Urologist the clear, accurate insights you need to decide the next clinical steps.

Researchers are studying the utility of MPS 2.0 in patients on active surveillance and in patients newly diagnosed with prostate cancer considering active surveillance.

However, MPS 2.0 was developed and validated in patients not previously diagnosed with prostate cancer. Therefore, it has not been evaluated in patients on active surveillance and should not be used in these cases."

Although it's technically "off-thread" I'll provide perplexity AI's answer regarding imaging and the detection of biological reoccurrence, primarily to give an understanding of the power of this particular AI engine.

The most amazing thing about the particular question/answer that I list below is that it is the result of an "improved question" that perplexity recommended I ask, after it answered my relatively simple question that lacked specificity.

There were many more recommended "improved questions" which could also have been asked.... I list some of them at the bottom of my response.

The answers are always comprehensive and based on multiple sources this AI engine finds by performing "real time" internet searching.

I'm just scratching the surface of the power of this format and recommend you "put it to the test" yourself.

Q: How does next-generation imaging compare to conventional imaging in detecting prostate cancer recurrence?

A: Next-generation imaging (NGI) techniques have demonstrated significant advantages over conventional imaging methods in detecting prostate cancer recurrence. Here's a comparison of their performance:

Sensitivity and Detection Rates

Conventional Imaging
• CT scans and bone scans have low detection rates for recurrent disease, especially at low PSA levels:
o Less than 5% for bone scans
o Less than 15% for CT scans when PSA is under 10 ng/mL.

Next-Generation Imaging
• PET imaging, particularly with novel radiotracers, shows much higher sensitivity:
o PSMA PET-CT has detection rates of 46-50% at PSA levels as low as 0.2-0.49 ng/mL
o Choline PET has a detection rate of 62% for recurrent disease.
o 18F-fluciclovine (Axumin) PET can detect recurrence at PSA levels of 0.5-1 ng/mL.

Specificity and Accuracy
NGI techniques generally offer improved specificity compared to conventional methods:
• PSMA PET-CT has shown positive predictive values of 84-92% for detecting biochemical recurrence.
• 18F-DCFPyL and rhPSMA-7.3 tracers have demonstrated positive predictive values of 89% and 92%, respectively.

Early Detection of Micrometastases

NGI, especially PSMA PET-CT, has superior ability to detect micrometastases and small-volume disease that conventional imaging often misses.

This allows for earlier detection of recurrence at lower PSA levels.

Impact on Clinical Management
The improved detection capabilities of NGI have significant implications for patient care:
• NGI can alter treatment decisions in up to 70% of patients with biochemical recurrence.
• It enables more precise localization of recurrent disease, allowing for targeted treatments like salvage radiation therapy.

Guidelines and Recommendations
Medical societies are increasingly recommending NGI for evaluating biochemical recurrence:
• The National Comprehensive Cancer Network now prioritizes PSMA PET-CT as the imaging method of choice for biochemical recurrence.
• European and US medical societies have provided specific recommendations for using NGI in biochemical recurrence evaluation.

In conclusion, next-generation imaging techniques, particularly PET-CT with novel radiotracers like PSMA, offer significantly improved sensitivity, specificity, and detection rates compared to conventional imaging for prostate cancer recurrence.

This enhanced performance allows for earlier detection and more accurate localization of recurrent disease, potentially leading to better-informed treatment decisions and improved patient outcomes.

Recommended follow-up questions included:

What are the specific advantages of using PET/CT over conventional imaging for prostate cancer recurrence?

How do PSA levels affect the detection rates of next-generation imaging technologies?

What are the limitations of current next-generation imaging technologies in prostate cancer detection?

How has the recommendation for using NGI in biochemical recurrence evolved over time?

What impact does next-generation imaging have on treatment strategies for prostate cancer patients?