V Vlaeminck-Guillem1, M Devonec2, D Champetier3, M Decaussi-Petrucci4, P Paparel2, P Perrin2, A Ruffion5. 1. Unité d'oncologie moléculaire et transfert, service de biochimie et biologie moléculaire sud, centre hospitalier Lyon-Sud, hospices civils de Lyon, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Centre de recherche en cancérologie de Lyon, Inserm 1052 CNRS 5286, centre Léon-Bérard, université Lyon 1, 69373 Lyon cedex 08, France; Faculté de médecine Lyon Est, université Lyon 1, 8, avenue Rockefeller, 69003 Lyon, France. Electronic address: virginie.vlaeminck-guillem@univ-lyon1.fr. 2. Service d'urologie, centre hospitalier Lyon-Sud, hospices civils de Lyon, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Faculté de médecine Lyon-Sud, université Lyon 1, chemin du Petit-Revoyet, 69921 Oullins cedex, France. 3. Service d'urologie, centre hospitalier Lyon-Sud, hospices civils de Lyon, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. 4. Centre de recherche en cancérologie de Lyon, Inserm 1052 CNRS 5286, centre Léon-Bérard, université Lyon 1, 69373 Lyon cedex 08, France; Faculté de médecine Lyon-Sud, université Lyon 1, chemin du Petit-Revoyet, 69921 Oullins cedex, France; Laboratoire d'anatomie et cytologie pathologiques, centre hospitalier Lyon-Sud, hospices civils de Lyon, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. 5. Centre de recherche en cancérologie de Lyon, Inserm 1052 CNRS 5286, centre Léon-Bérard, université Lyon 1, 69373 Lyon cedex 08, France; Service d'urologie, centre hospitalier Lyon-Sud, hospices civils de Lyon, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Faculté de médecine Lyon-Sud, université Lyon 1, chemin du Petit-Revoyet, 69921 Oullins cedex, France.
Abstract
AIM: To evaluate the performance of urinary PCA3 test to predict prostate biopsy outcome in a large French cohort. PATIENTS AND METHODS: A urine sample was prospectively obtained in 1015 patients undergoing prostate biopsies to determine the PCA3 score. The predictive value of PCA3 was explored using receiver operating characteristic curve analysis (ROC), multivariable logistic regression analysis and decision curve analysis. RESULTS: The median PCA3 score was significantly higher in patients with positive biopsies. The PCA3 score AUC was 0.76 (0.73-0.79), significantly higher than that of PSA (0.55; 0.51-0.58). At the cut-off of 35, sensitivity was 68 %, specificity 71 %, positive and negative predictive values 67 % and 71 %, and accuracy 69 %. Using multivariate analysis, PCA3 score appeared as an independent predictor of biopsy outcome and its addition to a base model including usual clinico-biological parameters resulted in a significant increase in predictive accuracy. At the cut-off of 20, about 1/2 of the eventual useless biopsies would have been avoided while ignoring 7 % of cancers with Gleason score ≥ 7. PCA3 score did not correlate to Gleason score but correlated to tumor volume (proportion of invaded cores). CONCLUSION: Urinary PCA3 is a useful test with high diagnostic performance for early prostate cancer diagnosis. Its correlation with cancer aggressiveness seems rather represented by a link to prostate volume than Gleason score.
AIM: To evaluate the performance of urinary PCA3 test to predict prostate biopsy outcome in a large French cohort. PATIENTS AND METHODS: A urine sample was prospectively obtained in 1015 patients undergoing prostate biopsies to determine the PCA3 score. The predictive value of PCA3 was explored using receiver operating characteristic curve analysis (ROC), multivariable logistic regression analysis and decision curve analysis. RESULTS: The median PCA3 score was significantly higher in patients with positive biopsies. The PCA3 score AUC was 0.76 (0.73-0.79), significantly higher than that of PSA (0.55; 0.51-0.58). At the cut-off of 35, sensitivity was 68 %, specificity 71 %, positive and negative predictive values 67 % and 71 %, and accuracy 69 %. Using multivariate analysis, PCA3 score appeared as an independent predictor of biopsy outcome and its addition to a base model including usual clinico-biological parameters resulted in a significant increase in predictive accuracy. At the cut-off of 20, about 1/2 of the eventual useless biopsies would have been avoided while ignoring 7 % of cancers with Gleason score ≥ 7. PCA3 score did not correlate to Gleason score but correlated to tumor volume (proportion of invaded cores). CONCLUSION: Urinary PCA3 is a useful test with high diagnostic performance for early prostate cancer diagnosis. Its correlation with cancer aggressiveness seems rather represented by a link to prostate volume than Gleason score.
Keywords:
Biopsies prostatiques; Cancer de la prostate; Diagnosis; Diagnostic; PCA3; Prediction; Prostate biopsies; Prostate cancer; Prédiction; Test urinaire; Urinary test