Objective
To determine whether a combination of prostate cancer gene 3 (PCA3) and magnetic resonance
imaging (MRI) suspicion score (mSS) could further optimize detection of prostate cancer
on MRI fusion-targeted biopsy (MRF-TB) among men with no history of biopsy.
Materials and Methods
We included in this study 187 men presenting to our institution between June 2012
and August 2014 who underwent multiparametric MRI (mpMRI) and PCA3 before MRF-TB.
Biopsy results, stratified by biopsy indication and PCA3 score, were recorded. Receiver
operating characteristics curves and multivariable logistic regressions were used
to model the association of PCA3 and mSS with cancer detection on MRF-TB.
Results
PCA3 is associated with cancer detection on MRF-TB for men with no prior biopsies
(area under the curve: 0.67, 95% confidence interval: 0.59-0.76). Using a cutoff of
≥35, PCA3 was associated with cancer risk among men with mSS 2-3 (P = .004), but not among those with mSS 4-5 (P = .340). The interaction of PCA3 and mSS demonstrated significantly higher discrimination
for cancer than mSS alone (area under the curve: 0.83 vs 0.79, P = .0434).
Conclusion
Urinary PCA3 is associated with mSS and the detection of cancer on MRF-TB for men
with no prior biopsies. PCA3 notably demonstrates a high negative predictive value
among mSS 2-3. However, in the case of high-suspicion mpMRI, PCA3 is not associated
with cancer detection on MRF-TB, adding little to cancer diagnosis. Further studies
are needed to evaluate the utility of PCA3 in predicting cancer among men with normal
mpMRI.
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Article info
Publication history
Published online: August 23, 2016
Accepted:
August 12,
2016
Received:
May 17,
2016
Footnotes
Financial Disclosure: Herbert Lepor is co-owner of MedReviews, a member of the Speaker Bureau of Allergan, investor at Serenity, and consultant at Thera Coat and Biozeus. Samir S. Taneja is a consultant at Hitachi Aloka and Biobot, has royalties from Elsevier, and scientific trial investigator for Trod. The remaining authors declare that they have no relevant financial interests.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
