PCA3 Materials & News

Remzi M, Haese A, van Poppel H, de la Taille A, Stenzl A, Hennenlotter J, Marberger M. BJU Int 2010;106:1138-42

• This follow-up study in 51 selected men with one or two prior negative biopsies shows that an elevated/high PCA3 Score can predict the presence of prostate cancer (PCa) at a follow-up biopsy
• A prior European multi-centre study in 463 men with one or two negative biopsies scheduled for repeat biopsy showed that a higher PCA3 Score corresponded with a higher probability of a positive repeat biopsy¹. This analysis describes the follow-up of 155 men with a negative repeat biopsy but an elevated PCA3 Score (≥ 20). Initial study data were also analysed to evaluate relationships between clinical characteristics, PCA3 Score and presence of cancer at biopsy
• A follow-up biopsy was performed in 51 selected men; 55% of these biopsies contained PCa
• Men with a positive follow-up biopsy had a statistically significantly higher PCA3 Score than those with a negative follow-up biopsy and more often had HGPIN at prior biopsy (Table)
• A sub-analysis of initial study data1 in 463 men was also performed. This showed that men with a PCA3 Score ≥ 35 and a positive repeat biopsy had a statistically significantly higher PCA3 Score (mean 113.9, median 75.7) than those with a negative biopsy (mean 87.3, median 56.9; P=0.0470)
• Men with a negative repeat biopsy and a PCA3 Score ≥ 35 more often had HGPIN (33%) than men with a low PCA3 Score (19%; P=0.005)
• It was discussed that the positive follow-up biopsy rate of 55% in the selected population with an elevated PCA3 Score is higher than reported for men having a repeat biopsy (10-30%). Men with a positive follow-up biopsy also had a higher PCA3 Score than men with a negative biopsy. This suggests that an elevated/high PCA3 Score can predict the presence of PCa in men with a prior negative biopsy and that these men might require close follow-up. In men with a negative biopsy containing HGPIN, an elevated/high PCA3 Score may indicate close follow-up to reassure that potentially aggressive PCa is not missed

1)    Haese A, et al. Clinical utility of the PCA3 urine assay in European men scheduled for repeat biopsy. Eur Urol 2008;54:1081-8 

#: Wilcoxon Rank Sum test; $: Chi-square test

Editorial comment

This follow-up of men with an elevated/high PCA3 Score and a negative biopsy shows that a high PCA3 Score may be predictive for future biopsy outcome. A recent analysis of the REDUCE study also suggested that PCA3 may be useful in detecting undiagnosed cancer, as high PCA3 Scores measured in biopsy negative men at year 2 of the trial predicted biopsy outcome at year 4 of the trial. In clinical practice this would mean that in men with a negative biopsy but high PCA3 Score a close follow-up is needed. However, the predictive value of the PCA3 Score for future biopsy outcome needs to be further evaluated in appropriately designed trials.

More information: Article at PubMed