To evaluate the variability of prostate cancer gene 3 (PCA3) score on time course within an individual patient with elevated serum prostate specific antigen (PSA), undergoing a first or repeat prostate biopsy (Bx).
PATIENTS AND METHODS: 360 males of two Italian Institutions who had undergone at least two PCA3 assessments were selected: 97.5% of them were scheduled for first or repeat prostate Bx because of elevated PSA and/or positive digital rectal examination (DRE) Comparison of PCA3 score either in patients with negative Bx (normal parenchyma, benign prostatic hyperplasia BPH, chronic prostatitis, high-grade prostate intraepithelial neoplasia HG-PIN) or positive Bx was performed The evaluation of PCA3 repeated measures biological variability and its possible association with main patient characteristics (age, family history for prostate cancer, DRE, prostate volume, BPH, prostatitis and HG-PIN) was performed Three different cut-offs were used to test possible risk class changes, the standard (score=35), and two additional ones: 25 (FDA approved cut-off) and 50 (selected based on our previous research).
RESULTS: PCA3 scores varied significantly comparing men with a negative Bx (median 25, range 2-276) to a positive one (43, 7-331) (p< 0.001). Men with chronic prostatitis and HG-PIN had no significant difference in PCA3 score with other negative biopsy patients - The median time between the two PCA3 assessments was 16.2 months (range 3-53.7) No association was found between PCA3 repeated measures modifications and age, family history for prostate cancer, DRE, BPH, prostatitis, HG-PIN and use of 5-alpha-reductase inhibitors The variability of PCA3 on repeated measures confirmed the risk class for about 80% of patients; in the remaining 20% of patients, the risk class was upgraded in two thirds of them and downgraded in one third.
CONCLUSION: PCA3 score can be considered a stable marker over time in most cases. Anyway, there is a group of patients having a clinically notable risk class change, needing deeper investigations on the genesis of this phenomenon.
Written by:
De Luca S, Passera R, Cappia S, Bollito E, Randone DF, Milillo A, Papotti M, Porpiglia F. Are you the author?
Urology, San Luigi Gonzaga Hospital.
Reference: BJU Int. 2014 Jan 28. Epub ahead of print.
doi: 10.1111/bju.12654
PubMed Abstract
PMID: 24472071
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