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PCA3 and PCA3-Based Nomograms Improve Diagnostic Accuracy in Patients Undergoing First Prostate Biopsy
Department of Urology, University Hospital of Lyon Sud, Hospices Civils of Lyon, Pierre Bénite 69495, France
Medical Faculty of Lyon 1 University, Lyon 69000, France
Department of Pathology, University Hospital of Lyon Sud, Hospices Civils of Lyon, Pierre Bénite 69495, France
Medical Unit of Molecular Oncology and Transfer, Department of Biochemistry and Molecular biology, University Hospital of Lyon Sud, Hospices Civils of Lyon, Pierre Bénite 69495, France
* Author to whom correspondence should be addressed.
Received: 21 July 2013; in revised form: 7 August 2013 / Accepted: 23 August 2013 / Published: 29 August 2013
Abstract: While now recognized as an aid to predict repeat prostate biopsy outcome, the urinary PCA3 (prostate cancer gene 3) test has also been recently advocated to predict initial biopsy results. The objective is to evaluate the performance of the PCA3 test in predicting results of initial prostate biopsies and to determine whether its incorporation into specific nomograms reinforces its diagnostic value. A prospective study included 601 consecutive patients addressed for initial prostate biopsy. The PCA3 test was performed before ≥12-core initial prostate biopsy, along with standard risk factor assessment. Diagnostic performance of the PCA3 test was evaluated. The three available nomograms (Hansen’s and Chun’s nomograms, as well as the updated Prostate Cancer Prevention Trial risk calculator; PCPT) were applied to the cohort, and their predictive accuracies were assessed in terms of biopsy outcome: the presence of any prostate cancer (PCa) and high-grade prostate cancer (HGPCa). The PCA3 score provided significant predictive accuracy. While the PCPT risk calculator appeared less accurate; both Chun’s and Hansen’s nomograms provided good calibration and high net benefit on decision curve analyses. When applying nomogram-derived PCa probability thresholds ≤30%, ≤6% of HGPCa would have been missed, while avoiding up to 48% of unnecessary biopsies. The urinary PCA3 test and PCA3-incorporating nomograms can be considered as reliable tools to aid in the initial biopsy decision.
Keywords: urine biomarker; nomogram; initial prostate biopsy; prostate cancer; prostate cancer antigen 3
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Ruffion, A.; Devonec, M.; Champetier, D.; Decaussin-Petrucci, M.; Rodriguez-Lafrasse, C.; Paparel, P.; Perrin, P.; Vlaeminck-Guillem, V. PCA3 and PCA3-Based Nomograms Improve Diagnostic Accuracy in Patients Undergoing First Prostate Biopsy. Int. J. Mol. Sci. 2013, 14, 17767-17780.
Ruffion A, Devonec M, Champetier D, Decaussin-Petrucci M, Rodriguez-Lafrasse C, Paparel P, Perrin P, Vlaeminck-Guillem V. PCA3 and PCA3-Based Nomograms Improve Diagnostic Accuracy in Patients Undergoing First Prostate Biopsy. International Journal of Molecular Sciences. 2013; 14(9):17767-17780.
Ruffion, Alain; Devonec, Marian; Champetier, Denis; Decaussin-Petrucci, Myriam; Rodriguez-Lafrasse, Claire; Paparel, Philippe; Perrin, Paul; Vlaeminck-Guillem, Virginie. 2013. "PCA3 and PCA3-Based Nomograms Improve Diagnostic Accuracy in Patients Undergoing First Prostate Biopsy." Int. J. Mol. Sci. 14, no. 9: 17767-17780.