1208 URINARY PCA 3 AS A PREDICTOR FOR PROSTATE CANCER IN A COHORT OF 1928 MEN UNDERGOING INITIAL PROSTATE BIOPSY

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You have accessJournal of UrologyProstate Cancer: Detection and Screening I1 Apr 20121208 URINARY PCA 3 AS A PREDICTOR FOR PROSTATE CANCER IN A COHORT OF 1928 MEN UNDERGOING INITIAL PROSTATE BIOPSY K. Kent Chevli, Michael Duff, Changhong Yu, Brian Capuder, Ahmed Elshafei, Stephanie Malczewski, Michael Kattan, and J. Stephen Jones K. Kent ChevliK. Kent Chevli Buffalo, NY More articles by this author , Michael DuffMichael Duff Buffalo, NY More articles by this author , Changhong YuChanghong Yu Cleveland, OH More articles by this author , Brian CapuderBrian Capuder Cleveland, OH More articles by this author , Ahmed ElshafeiAhmed Elshafei Cleveland, OH More articles by this author , Stephanie MalczewskiStephanie Malczewski Buffalo, NY More articles by this author , Michael KattanMichael Kattan Cleveland, OH More articles by this author , and J. Stephen JonesJ. Stephen Jones Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1497AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES PCA 3 is a new urinary marker that is overexpressed in prostate cancer (PCa) cells. A ratio of urine PCA 3 mRNA to PSA mRNA has shown promise in predicting for presence of PCa in men undergoing repeat prostate biopsy (PBx). We aim to establish the predictive value of PCA 3 in a cohort of men who underwent PCA 3 testing prior to initial PBx. METHODS The records from a single organization were retrospectively reviewed. Clinical characteristics including age, PSA, family history, digital rectal exam (DRE) result, body mass index (BMI) and prostate volume (PV) were identified. The predictive value of PCA 3 was explored using non-parametric receiver operator characteristics (ROC) curve and multivariable logistic regression analysis compared with PSA. RESULTS 2054 men underwent PCA 3 analysis prior to initial PBx. 126 patients were excluded who underwent a saturation PBx. Of the total 1928 cohort the mean age was 65.6 ± 9.1 years and 6.9% had a first degree relative with PCa. The mean pretherapy PSA was 5.8 ± 10.2 ng/mL and 18.5% had an abnormal DRE exam. PCa was identified in 712 (36.9%) men. HGPIN alone was seen in 648 (34%). Of the 712 men with PCa 419 (59%) had a Gleason = 6 and 293 (41%) had high grade PCa (HGPCa) with Gleason > 7. The mean PCA3 are 47 and 62 for the patients with Gleason = 6 and > 7 respectively. On multivariable analysis PCA 3 was statistically significantly associated with both PCa (p < 0.0001) and HGPCa (p < 0.0001) after adjusting for PSA (p < 0.0001), age (p = 0.0058), FH (< 0.0001), abnormal DRE (p = 0.0014), PV (< 0.0001) and BMI (p = 0.3411). Including PCA3 in the established multivariable regression improved the predictive accuracy from 0.744 to 0.771(p = 0.01) for all cancer and from 0.802 to 0.816 (P = 0.05) for HGPCa. Using ROC PCA 3 alone outperformed PSA in the prediction of PCa (AUC = 0.677 vs. 0.593, p < 0.001) and HGPCa (AUC = 0.686 vs. 0.649, p = 0.027). Using a cutoff of 35, PCA 3 alone had a sensitivity of 0.57, specificity of 0.69, positive predictive value of 0.5 and negative predictive value of 0.73. We identified 279 patients with a normal DRE and PSA > 2.5 and < 4.0 ng/mL. In this cohort there was no statistical difference between PCA 3 and PSA in the detection of PCa, although the study was not adequately powered for this endpoint (AUC = 0.638 vs. 0.511, p = 0.35). CONCLUSIONS PCA 3 proved a useful tool in identifying patients at risk for PCa, and performs as well in the initial PBx setting as it does for patients with a prior negative PBx. To our knowledge this is the largest PCA 3 study population to date and these results suggest further exploration of the value of PCA 3 is warranted. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e489 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information K. Kent Chevli Buffalo, NY More articles by this author Michael Duff Buffalo, NY More articles by this author Changhong Yu Cleveland, OH More articles by this author Brian Capuder Cleveland, OH More articles by this author Ahmed Elshafei Cleveland, OH More articles by this author Stephanie Malczewski Buffalo, NY More articles by this author Michael Kattan Cleveland, OH More articles by this author J. Stephen Jones Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...