PCA3 News
Congress abstract
The value of the PCA3 Assay in guiding prostate biopsy decision in men with a prior negative biopsy
Haese A, de la Taille A, van Poppel H, Marberger M, Mulders P, Abbou C-C, Stenzl A, Huland H, Tinzl M, Remzi M, Feyerabend S, van Gils M, Stillebroer A, Schalken J. Eur Urol Suppl 2008;7:142(abs. 1018)
- This abstract was presented as a poster at the 23rd annual meeting of the European Association of Urology (EAU), 26-29 March, 2008, Milan, Italy.
- This European, multi-centre study in 463 men with 1-2 prior negative biopsies shows that the PCA3 test helps in guiding repeat biopsy decision in clinical practice.
- The PCA3 Score may be indicative for clinical stage and significance of prostate cancer (PCa).
28% of men had a positive repeat biopsy. - The higher the PCA3 Score, the greater the probability of a positive repeat biopsy.
- The mean PCA3 Score was statistically significantly higher in men with a positive repeat biopsy than in men with a negative repeat biopsy (P < 0.001; Table).
- The PCA3 Score was better than % free prostate specific antigen (PSA) for predicting repeat biopsy outcome.
- The clinical utility of the PCA3 Assay was independent of the number of prior biopsies, age, prostate volume and serum total PSA level.
- The PCA3 Scores were statistically significantly higher in men with clinical stage T2 vs. T1, Gleason score ³ 7 vs. < 7 (Table).
- The PCA3 Scores were statistically significantly higher in men ‘significant’ prostate cancer vs. indolent’ prostate cancer (Table).
- The PCA3 Score was statistically significantly higher in men with high-grade prostate intraepithelial neoplasia (HGPIN) vs. those without HGPIN.
Table
| PCA3 Score in: | N | Median | Mean | ± 95% CI | p-value |
|---|---|---|---|---|---|
| All men with negative repeat biopsy | 335 | 19.5 | 35.5 | 28.8-42.2 | |
| All men with positive repeat biopsy | 128 | 33.7 | 63.8 | 47.7-79.8 | <0.0001# |
| T1c T2 |
81 30 |
26.8 61.7 |
56.0 88.4 |
34.5-77.5 56.9-119.9 |
0.005 |
| Gleason score < 7 Gleason score ≥ 7 |
70 52 |
28.1 45.3 |
62.1 68.6 |
35.6-88.6 50.8-86.5 |
0.0401 |
| "Indolent" prostate cancer* "Significant" prostate cancer |
15 72 |
21.4 42.1 |
24.5 75.9 |
14.9-34.0 50.3-101.5 |
0.0059 |
CI: confidence interval; # vs. men with negative repeat biopsy
* defined as: clinical stage T1c, PSA density < 0.15, Gleason score biopsy ≤ 6, percent of positive cores ≤ 33%
Reviewed by
Prof. H. Van Poppel
Editorial comment
This European, multi-centre confirmatory study clearly shows the value of PCA3 in patients that are candidates for a repeat biopsy. It is clear that PCA3 is higher in patients with higher stage prostate cancer, a Gleason score above 7 and those with significant prostate cancer. It is important to guide the urologist and to counsel the patient about a more or less urgent second biopsy. It remains important to notice that still significant prostate cancer with a high Gleason score can be found in some exceptional patients despite a favourable PCA3 score. Also this needs to be discussed with the patient.
