title: Prostate cancer detection rate at repeat saturation biopsy: PCPT risk calculator versus PCA3 score versus case-finding protocol.
abstract: BACKGROUND
  To evaluate Prostate Cancer Prevention Trial (PCPT) risk calculator versus prostate cancer gene 3 (PCA3) score versus case-finding protocol accuracy in prostate cancer diagnosis in patients with prostate-specific antigen (PSA) below 10 ng/mL submitted to repeat saturation biopsy (SPBx).
  
  
  METHODS
  From December 2010 to December 2011, 100 patients (median 66 years) underwent a SPBx (median 30 cores); the indications for repeat biopsy were those of a case-finding protocol: PSA values between 4.1 ng/mL-10 ng/mL or 2.6 ng/mL-4 ng/mL with F/T PSA ≤ 25% and ≤ 20%, respectively.  All patients had negative digital rectal examination (DRE) and median PSA was 7.9 ng/mL.  The performance of PCPT risk calculator (alone, combined with PSA free/total ( F/T) or PCA3 score) and PCA3 score  in comparison with the case-finding protocol results (alone or combined with PCA3 score) was retrospectively evaluated in terms of detection rate for cancer and number of avoided biopsies.
  
  
  RESULTS
  Prostate cancer was found in 28 (28%) patients; in the presence and absence of prostate cancer median PCA3 score was 57 versus 35 (p < 0.05).  Using PCPT risk calculator (cut off probability of 25%) combined with PCA3 score no prostate cancer would be missed avoiding 8% of unnecessary biopsies.  PCA3 score > 20 missed 7.2% of cancer; the case-finding protocol combined with PCA3 score > 35 would save 22% of avoidable biopsies, missing no cancer if all patients with PSA F/T ≤ 15% would undergo prostate biopsy irrespective of PCA3 values.
  
  
  CONCLUSIONS
  PCA3 score improves PCPT risk calculator accuracy in prostate cancer diagnosis; moreover, PCA3 score combined with PSA F/T reduce number of unnecessary biopsies (about 20%).
authors: Urology Unit - Cannizzaro Hospital, Catania, Italy.
authors: Pietro
authors: P
authors: Pepe
authors: Francesco
authors: F
authors: Aragona
mesh_terms: D000368:Aged; D000951:Antigens, Neoplasm / Q000652:urine*; D001706:Biopsy; D051517:Digital Rectal Examination; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood / Q000235:genetics; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012333:RNA, Messenger / Q000652:urine; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D000951:Antigens, Neoplasm; D012333:RNA, Messenger; C479341:prostate cancer antigen 3, human; D017430:Prostate-Specific Antigen