title: Biopsy and treatment decisions in the initial management of prostate cancer and the role of PCA3; a systematic analysis of expert opinion.
abstract: OBJECTIVE
  The Prostate CAncer gene 3 (PCA3) assay may guide prostate biopsy decisions and predict prostate cancer (PCa) aggressiveness. This study explored the appropriateness of (1) PCA3 testing; (2) biopsy; (3) active surveillance (AS) and the value of the PCA3 Score for biopsy and AS decisions.
  
  
  METHODS
  Using the RAND/UCLA appropriateness method, 12 urologists assessed the appropriateness of PCA3, biopsy and AS for theoretical patient profiles, constructed by combining clinical variables. They individually scored the appropriateness for all profiles using a 9-point scale. Based on the median score and extent of agreement, the appropriateness for each profile was calculated.
  
  
  RESULTS
  The PCA3 Assay was mainly considered appropriate in men with ≥1 negative biopsy, PSA ≥ 3 ng/mL and life expectancy (LE) ≥10 years. A LE < 10 years, ≥2 negative biopsies and PCA3 Score <20 decreased biopsy appropriateness, while PSA ≥ 3 ng/mL and PCA3 Score >50 increased it. In men without a prior biopsy, LE ≥ 10 years and a suspicious DRE, PCA3 did not affect biopsy appropriateness. In other men, a PCA3 Score <20 discouraged biopsy, while a value ≥35 supported biopsy. AS was mainly considered appropriate if LE < 10 years, T1c PCa, ≤20% positive cores and PSA < 3 ng/mL. A PCA3 Score <20 pleads for and higher scores (particularly >50) against AS.
  
  
  CONCLUSIONS
  These findings illustrate in which men PCA3 can be of additional value when taking biopsy and treatment decisions in clinical practice.
authors: Service d'Urologie, Cliniques Universitaires Saint-Luc UCL, Avenue Hippocrate, 10, 1200 Bruxelles, Belgium. bertrand.tombal@uclouvain.be
authors: Bertrand
authors: B
authors: Tombal
authors: Filip
authors: F
authors: Ameye
authors: Alexandre
authors: A
authors: de la Taille
authors: Theo
authors: T
authors: de Reijke
authors: Paolo
authors: P
authors: Gontero
authors: Alexander
authors: A
authors: Haese
authors: Paul
authors: P
authors: Kil
authors: Paul
authors: P
authors: Perrin
authors: Mesut
authors: M
authors: Remzi
authors: Jörg
authors: J
authors: Schröder
authors: Mark
authors: M
authors: Speakman
authors: Alessandro
authors: A
authors: Volpe
authors: Bianca
authors: B
authors: Meesen
authors: Herman
authors: H
authors: Stoevelaar
mesh_terms: D000951:Antigens, Neoplasm / Q000032:analysis* / Q000235:genetics; D001707:Biopsy, Needle; D003657:Decision Making; D019468:Disease Management; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000235:genetics* / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D000951:Antigens, Neoplasm; C479341:prostate cancer antigen 3, human