The role of PCA3 testing in patients with a raised prostate-specific antigen level after Greenlight photoselective vaporization of the prostate.
OBJECTIVE
Greenlight(®) photoselective vaporization of the prostate (PVP) is an effective method for treating men with lower urinary tract symptoms. A rise in prostate specific antigen (PSA) levels, however, may be noticed in some patients during follow-up. The aim of this study was to determine whether the prostate cancer gene 3 (PCA3) urinary test would help identify patients who were in need of a prostate biopsy.


METHODS
The PSA of all patients undergoing PVP were analyzed. Patients with an elevated (above reference range) or rising PSA level (defined as > 0.75 ng/mL/year if the PSA was between 4.1 and 10 or a doubling time of less than 2 years) were offered a transrectal ultrasonography (TRUS) guided prostate biopsy. Before the biopsy procedure, all patients had a PCA3 test. The relationships between PSA, PCA3, and TRUS prostate biopsy findings were analyzed to determine sensitivity and specificity for the PCA3 test in this setting.


RESULTS
50 patients were identified. The mean age was 69.97 (range 57-83) years. The mean PSA level was 10.1 ng/mL (range 3.03-44.2 ng/mL). Six patients were found to have prostate cancer. Of those, five patients had a positive PCA3 test. One patient had a negative PCA3 test but positive biopsy findings. This gives a sensitivity of 83.3%, and a positive predictive value of 21.7%. The negative predictive value was 96%.


CONCLUSIONS
The results suggest that a negative PCA3 test in our group of patients is a good predictor of negative biopsy results. The low positive predictive value may be an artefact of the group size. This will need further investigation and greater patient numbers to determine.
Henderson
James
J
Department of Urology, Broomfield Hospital, Mid Essex Hospital NHS Trust, Chelmsford, England. james.henderson@meht.nhs.uk
Ghani
Khurshid R
KR
Cook
Joanne
J
Fahey
Michael
M
Schalken
Jack
J
Thilagarajah
Ranjan
R
D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000652:urine*; D003710:Demography; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery* / Q000652:urine; D012372:ROC Curve; D014463:Ultrasonography
D000951:Antigens, Neoplasm; C479341:prostate cancer antigen 3, human