Carmona Echeverria, Lina;
(2020)
Improving The Diagnosis And Risk Stratification Of Prostate Cancer.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
The current diagnostic and stratification pathway for prostate cancer has led to over-diagnosis and over- treatment. This thesis aims to improve the prostate cancer diagnosis pathway by developing a minimally invasive blood test to inform diagnosis alongside mpMRI and to understand the true Gleason 4 burden which will help better stratify disease and guide clinicians in treatment planning. To reduce the number of patients who have to undergo prostate biopsy after indeterminate or false positive prostate mpMRI, we aimed to develop a new panel of mRNA detectable in blood or urine that was able to improve the detection of clinical significant prostate cancer (Gleason 4+3 or ≥6mm) in combination with prostate mpMRI. mRNA expression of 28 potential genes was studied in four prostate cancer cell lines and, using publicly available datasets, a new seven gene biomarker panel was developed using machine learning techniques. The signature was then validated in blood and urine samples from the ProMPT, PROMIS and INNOVATE trials. To redefine the classification of Gleason 4 disease in prostate cancer patients, digital pathology was used to contour and accurately assess the burden and spread of Gleason 4 in a cohort of PROMIS patients compared to the gold standard manual pathology. There was a significant difference between observed and objective Gleason 4 burden that has implications in patient risk stratification and biomarker discovery. The work presented in this thesis makes a significant step toward improving the patient diagnostic and risk classification pathways by ensuring only the right patients are biopsied when necessary, improving the current pathological reference standard.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Improving The Diagnosis And Risk Stratification Of Prostate Cancer |
| Event: | UCL |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2020. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| Keywords: | biomarkers, prostate cancer, diagnosis, Gleason 4, digital pathology |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10113862 |
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