PCA3 Materials & News

Ward JF, Chun F, Graefen M, Huland H, Köllerman J, Sauter G, Babaian RJ, Haese A. Eur Urol Suppl 2009;8:293 (abs. 690)

• This abstract was presented as a poster at the 24th annual meeting of the European Association of Urology (EAU), 17-21 March 2009 in Stockholm, Sweden
• This study in 189 patients with prostate cancer (PCa) undergoing radical prostatectomy shows that the PCA3 Score may be indicative of pathologically confirmed insignificant PCa
• Univariate analysis showed that the number of positive cores, biopsy Gleason score, prostate specific antigen density (PSAD), and the PCA3 Score were statistically significant risk factors for insignificant PCa (according to the Epstein criteria: pT2, Gleason score ≤ 3+3, tumour volume ≤ 0.5 mL). The predictive accuracy was the highest for biopsy Gleason score (0.795), followed by PCA3 (0.776), number of positive cores (0.775) and PSAD (0.762)
• In multivariate analysis, only PCA3 was an independent, significant risk factor for insignificant PCa (P=0.02). Incorporating PCA3 into a multivariate model (including biopsy Gleason score, number of positive cores and PSAD) increased the predictive accuracy of the model from 89.7% to 92.7%
• The mean PCA3 Score was statistically significantly higher in men with pathologically significant PCa compared to men with insignificant PCa (Figure)
• It was concluded that PCA3 is a significant and independent predictor of pathologically confirmed insignificant PCa. Incorporation of PCA3 into a multivariate model increased the predictive accuracy of the model by 3%. This suggests that PCA3 may be useful to aid in the decision on whether active surveillance or curative therapy is appropriate in men with clinically localised PCa  

Editorial comment

Widespread use of PSA testing and increase awareness about prostate cancer screening has led to the increased detection of many “indolent” cancers, i.e. cancers that are unlikely to threaten men and could benefit from active surveillance rather than from aggressive treatment.

Avoiding overtreatment of these “indolent” prostate cancer is clearly the challenge we are facing in the next few years. Additional innovative tests are clearly needed, considering the limited value of predicting the indolent nature of a cancer based solely on PSA, digital rectal examination (DRE) and biopsy results.

Together with the results reported by Chun et al at the EAU 2009, poster N°623, the data presented here demonstrate that PCA3 may prove very useful in guiding patients and physicians in the difficult decision between active surveillance and active treatment.

More information: Abstract