Identifying men for a repeat prostate biopsy is a conundrum to urologists. Risk calculators (RCs) such as the European Randomized Study of Screening for Prostate Cancer (ERSPC) RCs have been developed to predict the outcome of prostate biopsies and have been shown to improve diagnostic accuracy compared to PSA alone. However, it was recently shown that the outcome for high-grade prostate cancer (PCa) upon biopsy tended to be underestimated in men with previous negative biopsies using ERSPC RC model 4. For these men, an individualized approach combining the clinical information with the outcome of biomarker-related urine tests may help to make a more informed decision. Two men, aged 66 and 69 respectively when presented in the clinic, show the typical dilemma of urologist and patient for electing repeat prostate biopsy. Both men had normal DRE findings, did not have a family history of PCa, presented with serum PSA values between 3 and 10 ng/ml and the first biopsies were negative for disease. The ERSPC RC4 did not indicate a biopsy in these men. The urinary molecular biomarker-based test for HOXC6 and DLX1, combining biomarker-expression profiling with clinical risk factors, resulted in SelectMDx Risk scores for these men that were higher than the cut-off of the test. Based on this outcome, mpMRI was performed with an outcome of PI-RADS ≥4 in both men. Histopathological evaluation of TRUS-guided biopsies confirmed high-grade PCa. The urinary molecular biomarker-based risk score played a pivotal role in the diagnosis of clinically significant PCa whereas ERSPC RC4 outcome would not have indicated further diagnostic follow-up in these two cases. The timely diagnosis was shown to be crucial for the curative treatment by radical retropubic prostatectomy and the potential life-years gained for these two vital males.

中文翻译：

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使用基于尿分子生物标记物的风险评分诊断出的临床上具有重要意义的前列腺癌：两例病例报告

确定男性进行再次前列腺活检是泌尿科医师的难题。已经开发了风险计算器（RCs），例如欧洲前列腺癌筛查随机研究（ERSPC）RCs，可以预测前列腺活检的结果，并且与单独的PSA相比，可以提高诊断的准确性。但是，最近显示，使用ERSPC RC模型4，先前活检阴性的男性活检时，高级别前列腺癌（PCa）的结果往往被低估了。对于这些男性，结合临床信息和结果的个性化方法与生物标志物相关的尿液检查可能有助于做出更明智的决定。在诊所就诊时，分别为66岁和69岁的两名男子表现出泌尿科医师和患者选择再次进行前列腺穿刺活检的典型难题。两名男子的DRE结果均正常，没有PCa家族史，血清PSA值介于3 ng / ml和10 ng / ml之间，并且首次活检对疾病呈阴性。ERSPC RC4没有表明这些男性中有活检。基于尿液分子生物标记物的HOXC6和DLX1测试结合了生物标记物的表达谱和临床风险因素，得出这些男性的SelectMDx风险评分高于该检测的临界值。基于此结果，在两名男性中进行mpMRI的结果均为PI-RADS≥4。TRUS引导的活检组织病理学评估证实了高品位PCa。基于尿液分子生物标志物的风险评分在临床意义上重要的PCa的诊断中起着关键作用，而ERSPC RC4的结果在这两种情况下不会表明需要进一步的诊断随访。