Prostate Cancer Antigen 3 Score Accurately Predicts Tumour Volume and Might Help in Selecting Prostate Cancer Patients for Active Surveillance

Ploussard, Guillaume; Durand, Xavier; Xylinas, Évanguelos; Moutereau, Stéphane; Radulescu, C.; Forgue, A.; Nicolaı̈ew, Nathalie; Terry, Stéphane; Allory, Yves; Loric, Sylvain; Salomon, Laurent; Vacherot, Francis; Taille, Alexandre de la

doi:10.1016/j.eururo.2010.11.044

Cited by 134 publications

(72 citation statements)

References 29 publications

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“…The literature search identified 30 original articles that were included for review: 14 on magnetic resonance imaging (MRI) [8][9][10][11][12][13][14][15][16][17][18][19][20][21], 5 on serum markers [22][23][24][25][26], 5 on urinary markers [27][28][29][30][31], 4 on histopathology markers [32][33][34][35], and 2 on germline genetic markers [36,37]. Figure 1 presents the search strategy and study selection flowchart.…”

Section: Search Resultsmentioning

confidence: 99%

Novel Tools to Improve Patient Selection and Monitoring on Active Surveillance for Low-risk Prostate Cancer: A Systematic Review

Bergh

Ahmed

Bangma³

et al. 2014

European Urology

117

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Section: Search Resultsmentioning

confidence: 99%

Novel Tools to Improve Patient Selection and Monitoring on Active Surveillance for Low-risk Prostate Cancer: A Systematic Review

Bergh

Ahmed

Bangma³

et al. 2014

European Urology

117

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“…Gleason score (GS) was 6 in 26 cases (81.2%), 7 in 4 (12.5%) and 8 in 2 (6.3%). Median positive cores were 2 (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14] with the presence of either only one positive Diagnostic accuracy, sensitivity, specificity, PPV and NPV of PCA3 score cut-off of 20 vs 35 are listed in Table-1. ROC analysis demonstrated an AUC for PCA3 ≥ 20 vs PCA3 ≥ 35 of 0.678 and 0.634, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Recent studies have demonstrated that a PCA3 score of 35 provides an optimal balance between sensitivity and specificity in diagnosing PCa with greater diagnostic accuracy than free/total PSA (cut-off 25%) (7,10); on the other hand, a PCA3 score cut-off lower than 25 could be predictive of pathological indolent PCa (pIPCa) (11).…”

Section: Introductionmentioning

confidence: 99%

PCA3 score and prostate cancer diagnosis at repeated saturation biopsy. Which cut-off: 20 or 35?

et al. 2012

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ARTIcLE INFO _________________________________________________________ ___________________Purpose: To compare PCA3 score cut-off of 35 vs 20 in PCa diagnosis in patients undergoing repeated saturation prostate biopsy (SPBx). Material and Methods: From January 2010 to May 2011, 118 patients (median 62.5 years) with primary negative extended biopsy underwent a transperineal SPBx (median 30 cores) for persistent suspicion of PCa. The indications for repeated biopsy were: persistently high or increasing PSA values; PSA > 10 ng/mL, PSA values between 4.1-10 or 2.6-4 ng/mL with free/total PSA ≤ 25% and ≤ 20%, respectively; moreover, before performing SPBx urinary PCA3 score was evaluated. Results: All patients had negative DRE and median PSA was 8.5 ng/mL (range: 3.7-24 ng/mL). A T1c PCa was found in 32 patients (27.1%): PCA3 score was 59 (median; range: 7-201) in the presence of PCa and 35 (median; in the absence of cancer (p < 0.05). In the presence of ASAP and HGPIN median PCA3 score was 109 (range: 42-253) and 40 (range: 30-140), respectively. Diagnostic accuracy, sensitivity, specificity, PPV and NPV of PCA3 score cut-off of 20 vs 35 in PCa diagnosis were 44.9 vs 50%, 90.6 vs 71.9%, 27.9 vs 41.8%, 31.9 vs 31.5% and 88.9 vs 80%, respectively. ROC analysis demonstrated an AUC for PCA3 ≥ 20 vs ≥ 35 of 0.678 and 0.634, respectively. Conclusions: Our data suggest that PCA3 is more useful as an exclusion tool; moreover, setting a PCA3 cut-off at 20 vs 35, would have avoided 22.9 vs 38.1% of biopsies while missing 9.4% and 28% diagnosis of PCa.

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“…6 Recent reports described the use of PCA3 testing to identify patients with aggressive versus indolent prostate cancer. [9][10][11][12][13][14][15][16][17][18][19][20][21] Results of studies have been mixed. If the PCA3 test correlates with disease prognosis, it could be a valuable tool in identifying patients who are better treated with expectant management (e.g., aggressive follow-up of the tumor without radical treatment intervention) versus those better treated with curative therapy (e.g., surgery or radiation therapy).…”

Section: Background and Clinical Context For The Recommendationmentioning

confidence: 99%

“…[10][11][12][14][15][16][17][18]20,21 Three studies included data on biopsy results, 9,10,18 seven on prostatectomy results, 12,[14][15][16][17]20,21 and one on both. 11 Two studies were conducted on subjects in an active surveillance program.…”

Section: Clinical Utilitymentioning

confidence: 99%

Recommendations from the EGAPP Working Group: does PCA3 testing for the diagnosis and management of prostate cancer improve patient health outcomes?

Calonge

Klein

Berg

et al. 2014

Genetics in Medicine

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Summary of recommendations:The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group found insufficient evidence to recommend prostate cancer antigen 3 (PCA3) testing to inform decisions for when to rebiopsy previously biopsy-negative patients for prostate cancer or to inform decisions to conduct initial biopsies for prostate cancer in at-risk men (e.g., previous elevated prostate-specific antigen test or suspicious digital rectal examination).The EGAPP Working Group found insufficient evidence to recommend PCA3 testing in men with cancer-positive biopsies to determine if the disease is indolent or aggressive in order to develop an optimal treatment plan.Based on the available evidence, the overall certainty of clinical validity to predict the diagnosis of prostate cancer using PCA3 is deemed "low. " The EGAPP Working Group discourages clinical use for diagnosis unless further evidence supports improved clinical validity.Based on the available evidence, the overall certainty of net health benefit is deemed "low. " The EGAPP Working Group discourages clinical use unless further evidence supports improved clinical outcomes.Rationale: It has been suggested that PCA3 testing in the general male population might lead to earlier diagnosis and management changes (e.g., earlier detection and earlier initiation or higher rates of medical interventions) that improve outcomes. EGAPP Working Group found no direct evidence to support this possibility, so we sought indirect evidence aimed at documenting the extent to which PCA3 testing alters prostate cancer diagnosis or management, alone and in combination with traditional clinical management factors, and the extent to which this testing improves health outcomes.Analytic validity: Assay-related evidence was deemed adequate for the PROGENSA PCA3 assay approved by the US Food and Drug Administration, available from Gen-Probe. Very few studies were available that investigated preanalytical effects, analytical performance, and diagnostic accuracy of other quantitative assays for PCA3.Clinical validity: Evidence on clinical validity was rated inadequate to derive any conclusions about performance of PCA3 testing to inform decisions for when to rebiopsy previously biopsy-negative patients for prostate cancer, or to inform decisions to conduct initial biopsies for prostate cancer in at-risk men (e.g., previous elevated prostate-specific antigen test or suspicious digital rectal examination). Furthermore, there was little evidence to derive any conclusions about performance of PCA3 testing in men with cancer-positive biopsies to determine if the disease is indolent or aggressive in order to develop an optimal treatment plan. Clinical utility:No studies were available to provide direct evidence on the balance of benefits and harms related to PCA3 testing for diagnosis and management in the general male population. Evidence for other populations (e.g., high risk) was not evaluated in the review.

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Prostate Cancer Antigen 3 Score Accurately Predicts Tumour Volume and Might Help in Selecting Prostate Cancer Patients for Active Surveillance

Cited by 134 publications

References 29 publications

Novel Tools to Improve Patient Selection and Monitoring on Active Surveillance for Low-risk Prostate Cancer: A Systematic Review

Novel Tools to Improve Patient Selection and Monitoring on Active Surveillance for Low-risk Prostate Cancer: A Systematic Review

PCA3 score and prostate cancer diagnosis at repeated saturation biopsy. Which cut-off: 20 or 35?

Recommendations from the EGAPP Working Group: does PCA3 testing for the diagnosis and management of prostate cancer improve patient health outcomes?

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