TITLE:
The Use of PCA3 Can Reduce the Number of Prostate Biopsies Performed in a Community-Based Urologic Practice
AUTHORS:
Bradley M. Boelkins, Christopher M. Whelan, Richard J. Kahnoski, Jonathan Todd Bolthouse, Brian R. Lane
KEYWORDS:
Prostate Cancer; Prostate Cancer Antigen 3 (PCA3); Prostate Biopsy
JOURNAL NAME:
Open Journal of Urology,
Vol.3 No.5,
September
4,
2013
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.