Clinical utility of the prostate cancer gene 3 (PCA3) urine assay in Japanese men undergoing prostate biopsy

Authors


Abstract

What's known on the subject? and What does the study add?

  • It is known that a prostate cancer gene 3 (PCA3) urine assay is superior to serum PSA level or PSA-related indices for predicting a positive biopsy result in European and US men.
  • This is the first report on PCA3 in a large cohort of Japanese men. The diagnostic value of the PCA3 score in Japanese men was similar to those reported in European and US men. The study concludes that a combination of PSA density and PCA3 score may be useful for selecting patients who could avoid an unnecessary biopsy.

Objective

  • To examine the diagnostic performance of the prostate cancer gene 3 (PCA3) score for prostate cancer in Japanese men undergoing prostate biopsy.

Patients and Methods

  • This Japanese, multicentre study included 647 Asian men who underwent extended prostate biopsy with elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE).
  • Urine samples were collected after DRE.
  • The PCA3 score was determined using a PROGENSA PCA3 assay and correlated with biopsy outcome. Its diagnostic accuracy was compared with that of serum PSA level, prostate volume (PV), PSA density (PSAD), and free/total PSA ratio (f/t PSA).

Results

  • A total of 633 urine samples were successfully analysed (the informative rate was 98%). Median PSA was 7.6 ng/mL.
  • Biopsy revealed cancer in 264 men (41.7%). The PCA3 score for men with prostate cancer was significantly higher than that for men with negative biopsies (median PCA3 score: 49 vs. 18; P < 0.001). The rate of positive biopsy was 16.0% in men with a PCA3 score of <20 and 60.6% in those with a PCA3 score of ≥50.
  • Using a PCA3 score threshold of 35, sensitivity and specificity were 66.5 and 71.6%, respectively.
  • The area under the curve of the PCA3 score was significantly higher than that of the f/t PSA in men with PSA 4–10 ng/mL (0.742 vs 0.647; P < 0.05).
  • In men with PSAD < 0.15 and PCA3 < 20, only three (4.2%) out of 72 men had prostate cancer.

Conclusions

  • The PCA3 score was significantly superior to f/t PSA in predicting a positive biopsy result for prostate cancer in Japanese men with PSA 4–10 ng/mL.
  • The combination of PSAD and PCA3 score may be useful for selecting patients who could avoid an unnecessary biopsy.

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