Can urinary PCA3 supplement PSA in the early detection of prostate cancer?

Given the limited sensitivity and specificity of prostate-specific antigen (PSA), its widespread use as a screening tool has raised concerns for the overdiagnosis of low-risk and the underdiagnosis of high-grade prostate cancer. To improve early-detection biopsy decisions, the National Cancer Instit...

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Vydané v:Journal of clinical oncology Ročník 32; číslo 36; s. 4066
Hlavní autori: Wei, John T, Feng, Ziding, Partin, Alan W, Brown, Elissa, Thompson, Ian, Sokoll, Lori, Chan, Daniel W, Lotan, Yair, Kibel, Adam S, Busby, J Erik, Bidair, Mohamed, Lin, Daniel W, Taneja, Samir S, Viterbo, Rosalia, Joon, Aron Y, Dahlgren, Jackie, Kagan, Jacob, Srivastava, Sudhir, Sanda, Martin G
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 20.12.2014
Predmet:
Aged
Antigens, Neoplasm - urine
Biopsy
Early Detection of Cancer
Humans
Male
Middle Aged
Prospective Studies
Prostate - pathology
Prostate-Specific Antigen - blood
Prostatic Neoplasms - diagnosis
Risk Assessment
ISSN:1527-7755, 1527-7755
On-line prístup:Zistit podrobnosti o prístupe
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Popis
Shrnutí:Given the limited sensitivity and specificity of prostate-specific antigen (PSA), its widespread use as a screening tool has raised concerns for the overdiagnosis of low-risk and the underdiagnosis of high-grade prostate cancer. To improve early-detection biopsy decisions, the National Cancer Institute conducted a prospective validation trial to assess the diagnostic performance of the prostate cancer antigen 3 (PCA3) urinary assay for the detection of prostate cancer among men screened with PSA. In all, 859 men (mean age, 62 years) from 11 centers scheduled for a diagnostic prostate biopsy between December 2009 and June 2011 were enrolled. The primary outcomes were to assess whether PCA3 could improve the positive predictive value (PPV) for an initial biopsy (at a score > 60) and the negative predictive value (NPV) for a repeat biopsy (at a score < 20). For the detection of any cancer, PPV was 80% (95% CI, 72% to 86%) in the initial biopsy group, and NPV was 88% (95% CI, 81% to 93%) in the repeat biopsy group. The addition of PCA3 to individual risk estimation models (which included age, race/ethnicity, prior biopsy, PSA, and digital rectal examination) improved the stratification of cancer and of high-grade cancer. These data independently support the role of PCA3 in reducing the burden of prostate biopsies among men undergoing a repeat prostate biopsy. For biopsy-naive patients, a high PCA3 score (> 60) significantly increases the probability that an initial prostate biopsy will identify cancer.
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ISSN:1527-7755
1527-7755
DOI:10.1200/JCO.2013.52.8505