title: PCA3 urinary test versus 1H-MRSI and DCEMR in the detection of prostate cancer foci in patients with biochemical alterations.
abstract: OBJECTIVE
  To compare the prostate antigen 3 (PCA3) test with (1)H-magnetic resonance spectroscopic imaging ((1)H-MRSI) and dynamic contrast-enhanced magnetic resonance imaging (DCEMR) combined examination in the detection of prostate tumor foci in patients with persistently elevated prostate-specific antigen (PSA) levels and prior negative random transrectal ultrasound (TRUS)-guided biopsy.
  
  
  METHODS
  Forty-three patients with a first random biopsy negative for prostate adenocarcinoma, persistent elevated PSA and negative digital rectal examination were recruited. All the patients were submitted to MRSI examination (MRSI-DCEMR) and were submitted to an attentive prostate massage in order to perform PCA3 assay. Afterwards, 10-core laterally-directed random TRUS-guided prostate biopsy was performed.
  
  
  RESULTS
  The overall sensitivity and specificity of a PCA3 score ≥35 for positive biopsy were 76.9% and 66.6%, respectively, with a positive predictive value (PPV) of 80% and a negative predictive value (NPV) of 62.5%; as for MRSI sensitivity and specificity were, respectively, 92.8% and 86.6% with a PPV of 92.8% and a NPV of 86.6%. Receiver operating characteristic (ROC) analysis rates were 0.755 for PCA3 and 0.864 for MRSI.
  
  
  CONCLUSIONS
  Combined MRSI/DCEMR can better improve the cancer detection rate in patients with prior negative TRUS-guided biopsy and altered PSA serum levels than PCA3. Optimization of MRSI will allow more precise diagnosis of local invasion and improved bioptical procedures.
authors.affiliation: Department of Radiological Sciences, Sapienza Rome University Policlinico Umberto I, Rome, Italy. valeria.panebianco@gmail.com
authors.forename: Valeria
authors.initials: V
authors.lastname: Panebianco
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciarra
authors.forename: Ettore
authors.initials: E
authors.lastname: De Berardinis
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Busetto
authors.forename: Danilo
authors.initials: D
authors.lastname: Lisi
authors.forename: Valeria
authors.initials: V
authors.lastname: Buonocore
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Gentile
authors.forename: Franco
authors.initials: F
authors.lastname: Di Silverio
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D000328:Adult; D000951:Antigens, Neoplasm / Q000235:genetics / Q000652:urine*; D001707:Biopsy, Needle; D003287:Contrast Media; D051517:Digital Rectal Examination; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011467:Prostate / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood / Q000235:genetics; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D012333:RNA, Messenger / Q000235:genetics; D012372:ROC Curve; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014463:Ultrasonography; D036761:Ultrasound, High-Intensity Focused, Transrectal
chemical_list: D000951:Antigens, Neoplasm; D003287:Contrast Media; D012333:RNA, Messenger; C479341:prostate cancer antigen 3, human; D017430:Prostate-Specific Antigen