Articles

Prostate Cancer

Clinical Utility of the PCA3 Urine Assay in European Men Scheduled for Repeat Biopsy eulogo1

By: Alexander Haesea lowast , Alexandre de la Tailleb, Hendrik van Poppelc, Michael Marbergerd, Arnulf Stenzle, Peter F.A. Muldersf, Hartwig Hulandg, Clément-Claude Abboub, Mesut Remzid, Martina Tinzld, Susan Feyerabende, Alexander B. Stillebroerf, Martijn P.M.Q. van Gilsf and Jack A. Schalkenf

European Urology, Volume 54 Issue 1, November 2008, Pages 1081-1088

Published online: 01 November 2008

Keywords: Diagnostic methods, PCA3, Prostate biopsy, Prostate cancer, Prostate specific antigen, Sensitivity, Specificity

Abstract Full Text Full Text PDF (714 KB)

Abstract

Background

The Prostate CAncer gene 3 (PCA3) assay has shown promise as an aid in prostate cancer (pCA) diagnosis in identifying men with a high probability of a positive (repeat) biopsy.

Objective

This study evaluated the clinical utility of the PROGENSA PCA3 assay.

Design, setting, and participants

This European prospective, multicentre study enrolled men with one or two negative biopsies scheduled for repeat biopsy.

Measurements

After digital rectal examination (DRE), first-catch urine was collected to measure PCA3 mRNA concentration and to calculate the PCA3 score. The PCA3 score was compared to biopsy outcome. The diagnostic accuracy of the PCA3 assay was compared to percent of free prostate-specific antigen (%fPSA).

Results and limitations

In 463 men, the positive repeat biopsy rate was 28%. The higher the PCA3 score, the greater the probability of a positive repeat biopsy. The PCA3 score (cut-off of 35) had a greater diagnostic accuracy than %fPSA (cut-off of 25%). The PCA3 score was independent of the number of previous biopsies, age, prostate volume, and total prostate-specific antigen (PSA) level. Moreover, the PCA3 score was significantly higher in men with high-grade prostate intraepithelial neoplasia (HGPIN) versus those without HGPIN, clinical stage T2 versus T1, Gleason score ≥7 versus <7, and “significant” versus “indolent” (clinical stage T1c, PSA density [PSAD] <0.15ng/ml, Gleason score in biopsy ≤6, and percent positive cores ≤33%) pCA.

Conclusions

The probability of a positive repeat biopsy increases with rising PCA3 scores. The PCA3 score was superior to %fPSA for predicting repeat prostate biopsy outcome and may be indicative of clinical stage and significance of pCa.

Take Home Message

This study in men with 1–2 negative prostate biopsies demonstrates the clinical utility of the Prostate CAncer gene 3 (PCA3) assay in guiding decisions about which patients require repeat biopsy. The PCA3 score may also be indicative of the clinical stage and aggressiveness of prostate cancer.

Keywords: Diagnostic methods, PCA3, Prostate biopsy, Prostate cancer, Prostate specific antigen, Sensitivity, Specificity.

Footnotes

a Department of Urology, University Clinic Hamburg, Hamburg, Germany

b Hopital Henri Mondor, Créteil, France

c Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium

d University of Vienna, Vienna, Austria

e Uniklinikum Tübingen, Tübingen, Germany

f Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

g Martini-Clinic Prostate Cancer Center, University Clinic Hamburg, Hamburg, Germany

lowast Corresponding author. University Clinic Hamburg, Department of Urology, Martinistraße 52, 20246 Hamburg, Germany. Tel. +49 40 428033442; Fax: +49 40 428032444.

z.star Please visit www.eu-acme.org/europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.

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