WASHINGTON, DC USA (UroToday.com) - This presentation in a cohort of US-European patients suggests that the Prostate CAncer Gene 3 (PCA3) score may help identify pathologically insignificant prostate cancer (ICaP) and thus prove complementary to existing criteria for selecting patients for active surveillance.
One previously published report from Johns Hopkins University suggested that PCA3 did not contribute to identifying progression among active surveillance patients. PCA3 has been identified to predict small volume [tumor volume (TV) <0.5ml] and ICaP prior to RP. The researchers hypothesized that PCA3 would improve the multivariable accuracy in the prediction of pathological TV< 0.5ml and ICaP in a US-European cohort.
The database included complete retrospective clinical and pathological data of consecutive men who had undergone radical prostatectomy from two referral centers. Pre-operative PCA3 scores and computerized-assisted planimetrically measured tumor volume data were available in 160 patients. PCA3 scores were assessed using the Progensa assay®. In addition to standard clinical and TRUS/biopsy risk factors, five different PCA3 codings (continuously and cut-off 17, 24, 35, 47) were used in logistic regression models to identify five distinct pathological endpoints: a) low volume disease (<0.5ml), b) ICaP according to the Epstein criteria. Accuracy estimates of each endpoint were quantified using the area under the curve (AUC) of the receiver operator characteristic (ROC) analysis in models with and without PCA3.
They found that tumor volume <0.5 ml and pathological ICaP was present in 21.2% (n=34) and 10% (n=16) of patients. PCA3 scores were significantly lower in low volume disease and ICaP. AUC of multivariable low volume disease (+2.4 to +5.5%) and ICaP-models (+3 to +3.9%) increased when PCA3 was added to standard clinical risk factors. Their conclusion was that PCA3 is a valuable predictor of pathologically confirmed low volume disease and ICaP. They felt that it might help to select patients for active surveillance, but that this would require further study.
Presented by Marco Auprich, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.
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