The Use of PCA3 Can Reduce the Number of Prostate Biopsies Performed in a Community-Based Urologic Practice

Bradley M. Boelkins, Christopher M. Whelan, Richard J. Kahnoski, Jonathan Todd Bolthouse, Brian R. Lane

Michigan State University, East Lansing, USA.

DOI: 10.4236/oju.2013.35037                

Abstract

Purpose: It is now generally accepted that PSA screening identifies many prostate cancers that are low-risk and may not need treatment. PCA3 is a prostate cancer-specific marker with improved diagnostic accuracy when compared with PSA in research studies. It remains unknown whether PCA3 testing can reduce the unnecessary diagnosis and treatment of prostate cancer in routine practice. We evaluated whether the use of PCA3 in clinical practice decreases the number of biopsies being performed in response to PSA testing. Methods: 64 consecutive patients undergoing PCA3 measurement in a single community-based urology practice were analyzed for rates of biopsy performance and prostate cancer detection. Results: Median PSA was 5.0 (range: 0.4 - 38.6) and 50% had undergone prior biopsy without evidence of cancer. Median PCA3 score was 13.6 (range: 1.6 - 133.0) with 14 patients having an elevated PCA3 (>35). Prostate biopsy was avoided in 50 of 64 patients (78%). Of the 11 patients undergoing biopsy for abnormal PCA3, 7 had prostate cancer (64%). At >2-year median follow-up, 39 of the remaining 50 patients (78%) avoided subsequent biopsy. Only 5 prostate cancers were diagnosed during follow-up. Conclusions: When used in routine clinical practice, PCA3 appears to reduce the number of biopsies being performed in response to elevated PSA. Given the increasing interest in strategies to reduce unnecessary prostate cancer diagnosis and treatment, this FDA-approved and widely-available molecular test appears to achieve these goals. Further testing will clarify the role of PCA3 in initial and subsequent prostate cancer screening paradigms.

Keywords

Prostate Cancer; Prostate Cancer Antigen 3 (PCA3); Prostate Biopsy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	V. A. Moyer, on Behalf of the US Preventive Services Task Force, “Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement,” Annals of Internal Medicine, Vol. 157, No. 2, 2012, pp. 120-134.
[2]	R. J. Babaian, A. Toi, K. Kamoi, P. Troncoso, J. Sweet, R. Evans, et al., “A Comparative Analysis of Sextant and an Extended 11-Core Multisite Directed Biopsy Strategy,” Journal of Urology, Vol. 163, No. 1, 2000, pp. 152-157. doi:10.1016/S0022-5347(05)67993-1
[3]	C. K. Naughton, D. C. Miller, D. E. Mager, D. K. Ornstein and W. J. Catalona, “A Prospective Randomized Trial Comparing 6 versus 12 Prostate Biopsy Cores: Impact on Cancer Detection,” Journal of Urology, Vol. 164, No. 2, 2000, pp. 388-392. doi:10.1016/S0022-5347(05)67367-3
[4]	J. C. Presti Jr., J. J. Chang, V. Bhargava and K. Shinohara, “The Optimal Systematic Prostate Biopsy Scheme Should Include 8 Rather than 6 Biopsies: Results of a Prospective Clinical Trial,” Journal of Urology, Vol. 163, No. 1, 2000, pp. 163-167. doi:10.1016/S0022-5347(05)67995-5
[5]	B. Djavan, V. Ravery, A. Zlotta, P. Dobronski, M. Dobrovits, M. Fakhari, et al., “Prospective Evaluation of Prostate Cancer Detected on Biopsies 1, 2, 3 and 4: When Should We Stop?” Journal of Urology, Vol. 166, No. 5, 2001, pp. 1679-1683. doi:10.1016/S0022-5347(05)65652-2
[6]	G. I. Pinkhasov, Y. K. Lin, R Palmerola, P. Smith, F. Mahon, M. G. Kaag, et al., “Complications Following Prostate Needle Biopsy Requiring Hospital Admission or Emergency Department Visits—Experience from 1000 Consecutive Cases,” BJU International, Vol. 110, No. 3, 2012, pp. 369-374. doi:10.1111/ j.1464-410X.2011.10926.x
[7]	M. J. Bussemakers, A. van Bokhoven, G. W. Verhaegh, F. P. Smit, H. F. Karthaus, J. A. Schalken, et al., “DD3: A New Prostate-Specific Gene, Highly Overexpressed in Prostate Cancer,” Cancer Research, Vol. 59, No. 23, 1999, pp. 5975-5979.
[8]	J. B. de Kok, G. W. Verhaegh, R. W. Roelofs, D. Hessels, L. A. Kiemeney, T. W. Aalders, et al., “DD3(PCA3), a very Sensitive and Specific Marker to Detect Prostate Tumors,” Cancer Research, Vol. 62, No. 9, 2002, pp. 2695-2698.
[9]	D. Hessels, M. P. van Gils, O. van Hooij, S. A. Jannink, J. A. Witjes, G. W. Verhaegh, et al., “Predictive Value of PCA3 in Urinary Sediments in Determining ClinicoPathological Characteristics of Prostate Cancer,” Prostate, Vol. 70, No. 1, 2010, pp. 10-16. doi:10.1002/pros.21032
[10]	R. R. Goode, S. J. Marshall, M. Duff, E. Chevli and K. K. Chevli, “Use of PCA3 in Detecting Prostate Cancer in Initial and Repeat Prostate Biopsy Patients,” Prostate, Vol. 73, No. 1, 2012, pp. 48-53.
[11]	M. J. Roobol, F. H. Schroder, E. D. Crawford, S. J. Freedland, A. O. Sartor, N. Fleshner, et al., “A Framework for the Identification of Men at Increased Risk for Prostate Cancer,” Journal of Urology, Vol. 182, No. 5, 2009, pp. 2112-2120. doi:10.1016/j.juro.2009.07.018
[12]	J. Groskopf, S. M. Aubin, I. L. Deras, A. Blase, S. Bodrug, C. Clark, et al., “APTIMA PCA3 Molecular Urine Test: Development of a Method to Aid in the Diagnosis of Prostate Cancer,” Clinical Chemistry, Vol. 52, No. 6, 2006, pp. 1089-1095. doi:10.1373/clinchem.2005.063289
[13]	J. I. Epstein, D. W. Chan, L. J. Sokoll, P. C. Walsh, J. L. Cox, H. Rittenhouse, et al., “Nonpalpable Stage T1c Prostate Cancer: Prediction of Insignificant Disease Using Free/Total Prostate Specific Antigen Levels and Needle Biopsy Findings,” Journal of Urology, Vol. 160, No. 6, 1998, pp. 2407-2411.
[14]	M. C. Wang, L. A. Valenzuela, G. P. Murphy and T. M. Chu, “Purification of a Human Prostate Specific Antigen,” Investigative Urology, Vol. 17, No. 2, 1979, pp. 159-163.
[15]	M. Kuriyama, M. C. Wang, C. L. Lee, C. S. Killian, L. D. Papsidero, H. Inaji, et al., “Multiple Marker Evaluation in Human Prostate Cancer with the Use of Tissue-Specific Antigens,” Journal of the National Cancer Institute, Vol. 68, No. 1, 1982, pp. 99-105.
[16]	W. H. Cooner, B. R. Mosley, C. L. Rutherford Jr., J. H. Beard, H. S. Pond, W. J. Terry, et al., “Prostate Cancer Detection in a Clinical Urological Practice by Ultrasonography, Digital Rectal Examination and Prostate Specific Antigen,” Journal of Urology, Vol. 143, No. 6, 1990, pp. 1146-1154.
[17]	I. M. Thompson, D. P. Ankerst, C. Chi, M. S. Lucia, P. J. Goodman, J. J. Crowley, et al., “Operating Characteristics of Prostate-Specific Antigen in Men with an Initial PSA Level of 3.0 ng/ml or Lower,” JAMA, Vol. 294, No. 1, 2005, pp. 66-70. doi:10.1001/jama.294.1.66
[18]	I. M. Thompson, P. J. Goodman, C. M. Tangen, M. S. Lucia, G. J. Miller, L. G. Ford, et al., “The Influence of Finasteride on the Development of Prostate Cancer,” The New England Journal of Medicine, Vol. 349, No. 3, 2003, pp. 215-224. doi:10.1056/NEJMoa030660
[19]	S. Loeb, H. B. Carter, S. I. Berndt, W. Ricker and E. M. Schaeffer, “Complications after Prostate Biopsy: Data from SEER-Medicare,” Journal of Urology, Vol. 186, No. 5, 2011, pp. 1830-1834. doi:10.1016/j.juro.2011.06.057
[20]	E. D. Crawford, K. O. Rove, E. J. Trabulsi, J. Qian, K. P. Drewnowska, J. C. Kaminetsky, et al., “Diagnostic Performance of PCA3 to Detect Prostate Cancer in Men with Increased Prostate Specific Antigen: A Prospective Study of 1962 Cases,” Journal of Urology, Vol. 188, No. 5, 2012, pp. 1726-1731. doi:10.1016/j.juro.2012.07.023
[21]	A. K. Wu, A. C. Reese, M. R. Cooperberg, N. Sadetsky and K. Shinohara, “Utility of PCA3 in Patients Undergoing Repeat Biopsy for Prostate Cancer,” Prostate Cancer and Prostatic Diseases, Vol. 15, No. 1, 2012, pp. 100-105. doi:10.1038/pcan.2011.52