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. 2019 Jul 27;11(8):1064.
doi: 10.3390/cancers11081064.

Accuracy of Tumour-Associated Circulating Endothelial Cells as a Screening Biomarker for Clinically Significant Prostate Cancer

Free PMC article

Accuracy of Tumour-Associated Circulating Endothelial Cells as a Screening Biomarker for Clinically Significant Prostate Cancer

Sebastian Chakrit Bhakdi et al. Cancers (Basel). .
Free PMC article


Even though more than 350,000 men die from prostate cancer every year, broad-based screening for the disease remains a controversial topic. Guidelines demand that the only commonly accepted screening tool, prostate-specific antigen (PSA) testing, must be followed by prostate biopsy if results are elevated. Due to the procedure's low positive predictive value (PPV), however, over 80% of biopsies are performed on healthy men or men with clinically insignificant cancer-prompting calls for new ways of vetting equivocal PSA readings prior to the procedure. Responding to the challenge, the present study investigated the diagnostic potential of tumour-associated circulating endothelial cells (tCECs), which have previously been described as a novel, blood-based biomarker for clinically significant cancers. Specifically, the objective was to determine the diagnostic accuracy of a tCEC-based blood test to detect clinically significant prostate cancer (defined as Gleason score ≥ 3 + 4) in high-risk patients. Performed in a blinded, prospective, single-centre set-up, it compared a novel tCEC index test with transrectal ultrasound-guided biopsy biopsy as a reference on a total of 170 patients and found that a tCEC add-on test will almost double the PPV of a standalone PSA test (32% vs. 17%; p = 0.0012), while retaining a negative predictive value above 90%.

Keywords: PSA; clinically significant prostate cancer; diagnostic accuracy; grey zone; liquid biopsy; prostate cancer screening; tCEC; tumour-associated circulating endothelial cells.

Conflict of interest statement

The authors declare no conflict of interest.


Figure 1
Figure 1
Trial flow diagram. tCEC: tumour-associated circulating endothelial cells; TRUS biopsy: transrectal ultrasound-guided biopsy.
Figure 2
Figure 2
Workflow of tumour-associated circulating endothelial cell detection. WBC: white blood cells; RBC: red blood cells.
Figure 3
Figure 3
Diagnostic accuracy of the tCEC test for detection of clinically significant cancer in men with PSA readings <10 ng/mL on TRUS biopsy. tCEC: tumour-associated circulating endothelial cells, TRUS biopsy: transrectal ultrasound-guided biopsy. Primary definition: Sensitivity 75% (95% confidence interval (CI) 43–95), specificity 67% (53–79), positive predictive value 32% (16–52), negative predictive value 93% (80–98). Secondary definition: Sensitivity 71% (29–96), specificity 63% (50–75), positive predictive value 18% (6–37), negative predictive value 95% (83–99).

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