title: PCA3 score accuracy in diagnosing prostate cancer at repeat biopsy: our experience in 177 patients.
abstract: BACKGROUND
  To evaluate PCA3 score accuracy in prostate cancer (PCa) diagnosis in patients undergoing repeat saturation prostate biopsy (SPBx).
  
  
  METHODS
  From January 2010 to March 2012, 177 patients (median 64 years) with primary negative extended biopsy underwent a SPBx (median 28 cores) for persistent suspicion of PCa. The indications for repeat biopsy were: PSA > 10 ng/mL, PSA values between 4.1-10 or 2.6-4 ng/mL with free/total PSA < 25% and < 20%, respectively; moreover, before performing SPBx PCA3 score was evaluated.
  
  
  RESULTS
  Median PSA was 9.5 ng/mL (range: 3.7-28 ng/mL): in 74 (41.8%) cases PSA was > 10 ng/mL, in 99 (56%) and 4 (2.2%) was included between 4-10 and 2.6-4 ng/mL, respectively. Median PCA3 score was equal to 52 (range 3-273); 140 (79%) and 100 (56.5%) patients had a PCA3 score greater than 20 and 35, respectively. A T1c PCa was found in 48 patients (27.1%); PCA3 score was 60 (median; range: 7-208) in the presence of PCa and 34 (median; range: 3-268) in the absence of cancer (p < 0.05). Diagnostic accuracy, sensitivity, specificity, PPV and NPV of PCA3 score cut-off of 20 vs. 35 in PCa diagnosis were 43.5 vs. 50.2%, 91.7 vs. 73%, 25.6 vs. 41.8%, 31.5 vs. 35% and 89.5 vs. 80.6%, respectively.
  
  
  CONCLUSIONS
  PCA3 score reduce number of unnecessary repeat SPBx; using a PCA3 cut-off of 20 vs 35 would have avoided 21% vs. 37.8% of biopsies while missing 8.4% (4 cases) vs. 27% (13 cases) of significant PCa, respectively.
authors: Urology Unit, Giovanni Paolo II Hospital, Sciacca, Italy. barbera.mic@tiscali.it
authors: Michele
authors: M
authors: Barbera
authors: Pietro
authors: P
authors: Pepe
authors: Quintino
authors: Q
authors: Paola
authors: Francesco
authors: F
authors: Aragona
mesh_terms: D000368:Aged; D000951:Antigens, Neoplasm / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D015203:Reproducibility of Results
chemical_list: D000951:Antigens, Neoplasm; D015415:Biomarkers; C479341:prostate cancer antigen 3, human; D017430:Prostate-Specific Antigen