# Rapid Decentralized Prostate Cancer Risk Stratification by Portable Liquid Biopsy Analysis within a Clinical Biosensor Validation Framework

## TL;DR

A portable biosensor called AVATAR enables fast, accurate prostate cancer risk assessment using urine samples, offering a faster and less invasive alternative to current lab-based methods.

## Contribution

The AVATAR biosensor provides a novel portable and decentralized method for prostate cancer risk stratification with superior performance compared to existing clinical tests.

## Key findings

- AVATAR achieved area-under-curve values of 0.88 in training and 0.86 in validation cohorts for prostate cancer risk stratification.
- The biosensor correlates molecular biomarkers in urine with comprehensive transcriptomic sequencing of matched tissue specimens.

## Abstract

Clinical liquid biopsy (e.g., blood or urine) specimens, as a minimally invasive source of crucial molecular information, continue to grow in importance for efficacious targeted cancer treatment. Yet, current molecular profiling technologies are still confined to centralized laboratory testing, which escalates testing costs, result turnaround time, and patient anxiety. Crucially, there is also a scarcity of purposeful clinical validation studies to rigorously evaluate emerging liquid biopsy technologies from research settings to facilitate clinical translation. Here, we report liquid biopsy biosensor advancements in achieving rapid, accurate, and decentralized molecular profiling of a clinically accredited prostate cancer (PCa) urinary circulating RNA biomarker panel. This biosensor approach, termed ‘Accelerated non‐inVasive bioAnalyte testing And Reporting’ (AVATAR), integrates accelerated isothermal assay chemistry and wireless mobile operation capabilities onto a portable electrochemical readout platform. AVATAR enables easy operational control and result display with a custom mobile app following liquid biopsy specimen collection. Using independent training (n = 124) and validation (n = 114) PCa clinical urinary specimen cohorts, we showed AVATAR achieved superior PCa risk stratification to current clinical PCa testing with area‐under‐curve values of 0.88 (95% confidence interval: 0.84−0.92) and 0.86 (95% confidence interval: 0.83−0.89), respectively within 55 min of assay time. To further accelerate AVATAR for using PCa liquid biopsies as a surrogate for invasive tissue sampling, we designed a tailored multi‐year PCa follow‐up study with individual patient liquid biopsy specimens showing strong molecular biomarker correlation with comprehensive transcriptomic sequencing of matched tissue specimens (n = 39). By creating this bespoke biosensor technology clinical translation framework, we demonstrated AVATAR for decentralized PCa liquid biopsy molecular profiling to augment clinical precision cancer management planning.

In this work, we showcased two significant scientific advances in (i) developing a portable biosensor technology for rapid decentralized prostate cancer urinary biomarker testing and reporting, with superior performance to current clinical testing practice; and (ii) proposing a clinical validation framework (for our biosensor development) which can be widely utilized to promote clinical translation of biosensor technologies in academia.