European Urology

Abstract

Background: DD3^PCA3 is the most prostate cancer-specific gene described to date. To assess the clinical utility of DD3^PCA3 a time-resolved fluorescence-based, quantitative RT-PCR analysis for DD3^PCA3 was developed.

Methods: The diagnostic potential of DD3^PCA3 was determined by quantitative measurement of DD3^PCA3 transcripts in non-malignant and malignant prostate specimens. Moreover, DD3^PCA3 transcripts were determined quantitatively in urine sediments obtained after prostatic massage. A cohort of 108 men, admitted for prostate biopsies based on a PSA of >3 ng/ml, was studied.

Results: Prostate tumors showed a 66-fold up-regulation of DD3^PCA3 (median 158.4·10⁵ copies/μg tissue RNA) when compared to benign prostate tissue (median 2.4·10⁵ copies/μg tissue RNA). This up-regulation was found in more than 95% of prostate cancer specimens studied. These data revealed that specimens with less than 10% of cancer cells could be accurately discriminated from non-cancer tissues. Hence, detection of a small fraction of prostate cancer cells in a background of normal cells seemed feasible. Therefore, this DD3^PCA3-based RT-PCR assay was used for the identification of prostate cancer in urine sediments obtained after prostatic massage. From 108 men with a serum PSA value >3 ng/ml, 24 men were shown to have prostate cancer upon biopsy. Of these 24 men, 16 were shown to be positive for DD3^PCA3, indicating a sensitivity of the assay of 67%. Furthermore, a negative predictive value of 90% was calculated.

Conclusion: The quantitative RT-PCR assay for DD3^PCA3 described, bears great promise as a tool for molecular urine analysis. It has great potential in reducing the number of unnecessary biopsies. A multi-center study using this DD3^PCA3 assay can provide the basis for the utility of molecular diagnostics in clinical urological practice.