title: Prostate cancer antigen 3 score accurately predicts tumour volume and might help in selecting prostate cancer patients for active surveillance.
abstract: BACKGROUND
  The optimal selection of prostate cancer (PCa) patients for active surveillance (AS) is currently being debated.
  
  
  OBJECTIVE
  To assess the impact of urinary prostate cancer antigen 3 (PCA3) score as an AS criterion instead of and in addition to the current criteria.
  
  
  METHODS
  We prospectively studied 106 consecutive low-risk PCa patients (prostate-specific antigen [PSA] ≤10 ng/ml, clinical stage T1c-T2a, and biopsy Gleason score 6) who underwent a PCA3 urine test before radical prostatectomy (RP).
  
  
  METHODS
  Performance of AS criteria (biopsy criteria, PCA3 score, PSA density, and magnetic resonance imaging [MRI] findings) was tested in predicting four prognostic pathologic findings in RP specimens: (1) pT3-4 disease; (2) overall unfavourable disease (OUD) defined by pT3-4 disease and/or pathologic primary Gleason pattern 4; (3) tumour volume <0.5 cm(3); and (4) insignificant PCa.
  
  
  CONCLUSIONS
  The PCA3 score was strongly correlated with the tumour volume in a linear regression analysis (p<0.001, r=0.409). The risk of having a cancer ≥0.5 cm(3) and a significant PCa was increased three-fold in men with a PCA3 score of ≥25 compared with men with a PCA3 score of <25 with most AS biopsy criteria used. There was a trend towards higher PCA3 scores in patients with unfavourable and non-organ-confined disease and Gleason >6 cancers. In a multivariate analysis taking into account each AS criterion, a high PCA3 score (≥25) was an important predictive factor for tumour volume ≥0.5 cm(3) (odds ratio [OR]: 5.4; p=0.010) and significant PCa (OR: 12.7; p=0.003). Biopsy criteria and MRI findings were significantly associated with OUD (OR: 3.9 and 5.0, respectively; p=0.030 and p=0.025, respectively).
  
  
  CONCLUSIONS
  PCA3 score may be a useful marker to improve the selection for AS in addition to the current AS criteria. With a predictive cut-off of 25, PCA3 score is strongly indicative for tumour volume and insignificant PCa.
authors.affiliation: Department of Urology, Pathology and Biochemistry, CHU Henri Mondor, APHP, Créteil, France. g.ploussard@gmail.com
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.forename: Xavier
authors.initials: X
authors.lastname: Durand
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: Stéphane
authors.initials: S
authors.lastname: Moutereau
authors.forename: Camélia
authors.initials: C
authors.lastname: Radulescu
authors.forename: Aurélien
authors.initials: A
authors.lastname: Forgue
authors.forename: Nathalie
authors.initials: N
authors.lastname: Nicolaiew
authors.forename: Stéphane
authors.initials: S
authors.lastname: Terry
authors.forename: Yves
authors.initials: Y
authors.lastname: Allory
authors.forename: Sylvain
authors.initials: S
authors.lastname: Loric
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Francis
authors.initials: F
authors.lastname: Vacherot
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
mesh_terms: D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000652:urine*; D014408:Biomarkers, Tumor / Q000652:urine*; D001706:Biopsy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C479341:prostate cancer antigen 3, human