Both the PCA3 urine biomarker and mpMRI aim to limit prostate cancer over-diagnosis and over-treatment by identifying less indolent cancer and more clinically significant cases. The objective of this study was to explore whether the utility of these tests can be maximized by combining them for a group of patients with previous negative biopsies.
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Patients included had a median age of 63 years (IQR 58-68), median PSA of 6.3 ng/mL (IQR 4.6-8.8), and abnormal PCA3 (≥35) in 32.5% of cases. In the multivariable model for predicting clinically significant prostate cancer, only age (OR 1.07, 95%CI 1.02-1.13), PIRADS score 4 (OR 10.3, 95%CI 2.8-38.3), PIRADS score 5 (OR 24.9, 95%CI 6.2-101.2), and abnormal PCA3 (OR 2.57, 95%CI 1.19-5.6) were significant. No patients with a negative mpMRI and normal PCA3 had clinically significant prostate cancer on subsequent biopsy (0 of 26, 100% NPV for double-negative test; p<0.001). Using mpMRI as the initial test diminished the number of overall tests (11 fewer tests per 100 patients) used, however is the most expensive approach that requires an expert radiologist and dedicated time/equipment. A limitation of the study includes the low number of men receiving a mpMRI with PIRADS 4 or 5 lesions, as suggested by the wide confidence intervals on multivariable modelling.
The authors concluded that both PCA3 and mpMRI are useful tests for predicting clinically significant prostate cancer on repeat prostate biopsy, as no patients in their cohort had clinically significant disease when both tests were negative. Perhaps a subsequent biopsy can be eliminated in this setting, although these results require external validation on larger and more heterogeneous groups of men.
Presented By: Nathan Perlis, MD, University of Toronto, University Health Network, Toronto, ON, Canada
Co-Authors: Thamir Al-Kasab, Ardalan E. Ahmad, Estee Goldberg, Kamel Fadaak, Rashid Sayyid, Antonio Finelli, Girish S. Kulkarni, Robert J. Hamilton, Alexandre Zlotta, Neil E. Fleshner
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre Twitter: @zklaassen_md at the 72nd Canadian Urological Association Annual Meeting - June 24 - 27, 2017 - Toronto, Ontario, Canada