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Relationship between Proclarix and the Aggressiveness of Prostate Cancer

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Abstract

Introduction

Proclarix is a CE-marked test that provides the risk of clinically significant prostate cancer (csPCa), ranging from 0% to 100%, based on the serum measurement of Thrombospondin-1, cathepsin D, prostate-specific antigen (PSA), and percentage of free PSA in addition to age. We hypothesize that Proclarix could be correlated with PCa aggressiveness. We analyzed the association of this new biomarker with four surrogates of aggressiveness: grade group (GG) in the biopsy, clinical stage, risk of biochemical recurrence after primary treatment of localized PCa, and pathology in the surgical specimen.

Material and Methods

This is a retrospective study from 606 men with suspicion of PCa [PSA of ≥ 3.0 ng/mL and/or abnormal digital rectal examination (DRE)], in whom Proclarix was assessed (0–100%). The GG was defined by the International Society of Urological Pathology categories. The TNM was used for clinical staging (cT based on DRE, whereas cN and cM were established with computed tomography and 99-technetium bone scintigraphy). The risk of biochemical recurrence of localized PCa after primary treatment was defined by combining PSA, GG, and cT. Finally, an unfavorable pathology in a surgical specimen was defined as GG > 2 or pT ≥ 3.

Results

The median age of the cohort was 67 years old, with a median PSA of 7 ng/mL and a rate of abnormal DRE of 23.3%. CsPCa was detected in 254 men (41.9%), with a median Proclarix of 60.1% compared with 37.3% obtained in patients with insignificant PCa and 20.7% in men without PCa. Among patients with GG > 3, Proclarix was significantly higher (58.2%) than in those with GG of 3 or lower (33.1%, p < 0.001). Men with localized tumors exhibited a Proclarix median of 37.3% compared with those with advanced disease (60.1%, p < 0.001). Proclarix levels among 197 patients with low and intermediate risk of biochemical recurrence were 24.9% and 35.0%, respectively, significantly lower compared with patients with high-risk disease (58.7%, p < 0.001). Unfavorable pathology was observed in 35 patients out of the 79 who underwent radical prostatectomy, with a Proclarix median of 35.7% compared with 23.7% obtained in patients with favorable pathology (p = 0.013). Proclarix and magnetic resonance imaging were independent predictors of the four surrogates of aggressiveness analyzed.

Conclusion

There is a correlation between Proclarix and the aggressiveness of PCa.

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Author notes

  1. Enrique Trilla and Juan Morote have contributed equally.

Authors and Affiliations

  1. Department of Urology, Vall d’Hebron Hospital, Passeig de la Vall d’Hebron 119, 08035, Barcelona, Spain

    Miriam Campistol, Marina Triquell, Lucas Regis, Ana Celma, Jacques Planas, Enrique Trilla & Juan Morote

  2. Prostate Cancer Research Group, Vall d’Hebron, Research Institute, 08035, Barcelona, Spain

    Lucas Regis, Ana Celma, Inés de Torres, María E. Semidey, Olga Mendez, Jacques Planas, Enrique Trilla & Juan Morote

  3. Department of Surgery, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain

    Miriam Campistol, Enrique Trilla & Juan Morote

  4. Department of Pathology, Vall d’Hebron Hospital, 08035, Barcelona, Spain

    Inés de Torres & María E. Semidey

  5. Department of Morphological Sciences, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain

    Inés de Torres & María E. Semidey

  6. Department of Radiology, Vall d’Hebron Hospital, 08035, Barcelona, Spain

    Richard Mast

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  1. Miriam Campistol
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Correspondence to Miriam Campistol.

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Funding

This research did not receive any specific support from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors (MC, MT, LR, AC, IdT, MES, RM, OM, JP, ET & JM) have no conflicts of interest to declare.

Data availability statement

The data presented in this study are available on request from the corresponding author.

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Written informed consent was obtained from all subjects involved in the study.

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Author contributions

All authors contributed to the study conception and design. Miriam Campistol, Juan Morote, and Enrique Trilla performed the study selection. Miriam Campistol drafted the manuscript and all authors commented on previous versions of the manuscript. Juan Morote, Enrique Trilla, Marina Triquell, Ana Celma, Lucas Regis, Jacques Planas, Inés de Torres, María E. Semidey, Richard Mast, and Olga Mendez critically revised the manuscript. All authors read and approved the final manuscript.

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Campistol, M., Triquell, M., Regis, L. et al. Relationship between Proclarix and the Aggressiveness of Prostate Cancer. Mol Diagn Ther 27, 487–498 (2023). https://doi.org/10.1007/s40291-023-00649-y

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