Publication
Auprich M, Bjartell A, Chun FKH, de la Taille A, Freedland SJ, Haese A, Schalken J, Stenzl A, Tombal B, van der Poel H. Eur Urol 2011;60:1045-54
- This systematic review of English-language papers published from 1999-February 2011 shows that PCA3, integrated in biopsy nomograms or risk-stratification tools, can be used to counsel or confirm biopsy indications. If confirmed in further studies, PCA3 together with established staging risk factors could also assist clinicians in specific pre-treatment decision making
- This systematic review evaluated the current clinical evidence investigating the role of PCA3 in screening, early detection, active surveillance (AS) and pre-operative staging of PCa. A systematic and comprehensive Medline search was performed using PCA3- and prostate cancer (PCa) related search terms. English language papers published from 1999-2011 were included
- A total of 47 PCA3 publications were selected; 9 basic papers, 19 papers related to PCa diagnosis, 7 papers related to PCa staging and 12 papers on new diagnostic and therapeutic concepts of PCA3
- Data from multi-centre trials show that PCA3 is a reliable predictor of PCa at biopsy, demonstrating superiority over PSA and %free PSA. When combined with established risk factors, PCA3 demonstrated improved accuracy and applicability of nomograms and risk calculators. As such PCA3 can assist clinicians in biopsy decision making in men at suspicion of having PCa
- Studies evaluating the use of PCA3 in screening and active surveillance protocols had several limitations. Therefore this needs to be further investigated in well-designed studies
- PCA3 has been shown to independently predict low-volume and insignificant PCa. However, it is not associated with locally advanced disease and is limited in the prediction of aggressive cancer. If confirmed in further studies, the use of PCA3 together with established staging risk factors could assist clinicians in pre-treatment decision making
- A recent analysis of the landmark Reduction by DUtasteride of Prostate Cancer Events (REDUCE) trial showed that the PCA3 Score was a significant predictor of a positive follow-up biopsy 2 years later [see also Validation of PCA3 in placebo arm of REDUCE trial confirms that the PCA3 Assay can help guide repeat biopsy decisions]
- Studies suggest that the PCA3 Score is relatively stable over time, even after interventional effects (e.g. biopsy) on prostate tissue
- Studies evaluating the combination of PCA3 with new (experimental) biomarkers (e.g. TMPRSS2-ERG fusion transcripts, GOLM1) have shown improved diagnostic accuracy in predicting biopsy outcome compared to either biomarker alone. These results should be confirmed in further and larger studies but may offer an interesting new perspective in the early detection of PCa
- Although the guidelines of the European Association of Urology (EAU) do not recommend the use of PCA3 in PCa detection, the authors of this systematic review indicate that there is growing level 2a evidence that PCA3 has value in identifying PCa, especially in men with an initial negative biopsy
- It was concluded that PCA3, integrated in novel biopsy nomograms or risk stratification tools, can be used to counsel or confirm biopsy indications. If confirmed in further studies, using PCA3 together with established staging risk factors, could assist clinicians in specific pre-treatment decision making. So far no evidence for the usefulness of PCA3 in active surveillance programs has been presented
More information: Abstract on PubMed