From the Desk of the Associate Editor: Utility of a PrCa Urinary Biomarker in Active Surveillance

The proof of concept for the utility of urinary biomarkers to predict biopsy outcome was published in 2003 by Hessels et al, which subsequently led to the launch of the PCA3 test in 2007.  The test was mostly used for repeat biopsy decisions, to which also the FDA approval in 2012 was confined. The potential utility in active surveillance settings was suggested by many and in their recent paper Tosoain et al study the value of a first PCA3 outcome (fPCA3) and a subsequent PCA3 test (sPCA3) to predict Grade Reclassification (GR) in men on active surveillance.

In 11% of the 260 men grade was reclassified (> GS 6), and the median value of both the fPCA3, as well as, sPCA3 was significantly higher in the GR cases. Another interesting point was the longitudinal trend in PCA3 values. So far, despite more than 400 paper published on PCA3, none report on longitudinal measurements of PCA3. The longitudinal (increase in log(PCA3)year-1) did not show any significant change between the two groups (GR + versus -). In summary both in univariate and multivariate models f- and sPCA3 show incremental prognostic information.

Interestingly, whereas the diagnostic value of PCA3 has been confirmed by the vast majority of studies, equivocal data on the prognostic value of PCA3 were reported. More recently, a prognostic urinary risk score was developed based on genes which were overexpressed in high-grade PrCa (HOXC6 and DLX1).  Active Surveillance studies in which the value of this urinary biomarker-based risk classifier is evaluated are eagerly awaited.

Written by: Jack A Schalken, Ph.D., Biochemist, Director of urological research, and Professor of experimental urology at Radboud University Medical Center, Nijmegen 

Read the PCAN Full-Text Article: Longitudinal Assessment Of Urinary PCA3 for Predicting Prostate Cancer Grade Reclassification In Favorable-Risk Men During Active Surveillance

1. Longitudinal assessment of urinary PCA3 for predicting prostate cancer grade reclassification in favorable-risk men during active surveillance. J J Tosoian, H D Patel, M Mamawala, P Landis, S Wolf, D J Elliott, J I Epstein, H B Carter, A E Ross, L J Sokoll & C P Pavlovich Prostate Cancer and Prostatic Diseases volume 20, pages 339–342 (2017)
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