ProsTAV, a novel blood-based test for biopsy decision management in significant prostate cancer

Background: Current pathways in early diagnosis of prostate cancer (PCa) can lead to unnecessary biopsy procedures. Here, we used telomere analysis to develop and evaluate ProsTAV®, a risk model for significant PCa (Gleason score >6), with the objective of improving the PCa diagnosis pathway. Methods: This retrospective, multicentric study analyzed telomeres from patients with serum PSA 3–10 ng/mL. High-throughput quantitative fluorescence in-situ hybridization was used to evaluate telomere-associated variables (TAVs) in peripheral blood mononucleated cells. ProsTAV® was developed by multivariate logistics regression based on three clinical variables and six TAVs. The predictive capacity and accuracy of ProsTAV® were summarized by receiver operating characteristic (ROC) curves and its clinical benefit with decision curves analysis. Results: Telomeres from 1043 patients were analyzed. The median age of the patients was 63 years, with a median PSA of 5.2 ng/mL and a percentage of significant PCa of 23.9%. A total of 874 patients were selected for model training and 169 patients for model validation. The area under the ROC curve of ProsTAV® was 0.71 (95% confidence interval [CI], 0.62–0.79), with a sensitivity of 0.90 (95% CI, 0.88–1.0) and specificity of 0.33 (95% CI, 0.24–0.40). The positive predictive value was 0.29 (95% CI, 0.21–0.37) and the negative predictive value was 0.91 (95% CI, 0.83–0.99). ProsTAV® would make it possible to avoid 33% of biopsies. Conclusions: ProsTAV®, a predictive model based on telomere analysis through TAV, could be used to increase the prediction capacity of significant PCa in patients with PSA between 3 and 10 ng/mL.