title: Urinary PCA3 as a predictor of prostate cancer in a cohort of 3,073 men undergoing initial prostate biopsy.
abstract: OBJECTIVE
  PCA3 is a urinary marker that has shown promise in predicting the presence of prostate cancer in men undergoing repeat prostate biopsy. We studied PCA3 before initial prostate biopsy.
  
  
  METHODS
  Records from a single organization were retrospectively reviewed. The predictive value of PCA3 was explored using nonparametric receiver operating characteristic curve analysis (ROC) and multivariable logistic regression analysis.
  
  
  RESULTS
  A total of 3,073 men underwent PCA3 analysis before initial prostate biopsy sampling of 12 to 14 areas. Mean PCA3 was 27.2 and 52.5 for patients without and with cancer, respectively. Prostate cancer was identified in 1,341 (43.6%) men. Overall 54.5% had Gleason 6 disease and 45.5% had Gleason 7 or greater (high grade prostate cancer). Mean PCA3 was 47.5 and 58.5 for the patients with Gleason 6 and 7 or greater disease, respectively. On multivariable logistic analysis PCA3 was statistically significantly associated with prostate cancer and high grade prostate cancer after adjusting for prostate specific antigen (p<0.001 for both), free prostate specific antigen (p=0.04 and p=0.01, respectively), age (p<0.001 for both), family history (p<0.001 and p=0.59, respectively), abnormal digital rectal examination (p=0.31 and p<0.001, respectively), prostate volume (p<0.001 for both) and body mass index (p<0.001 for both). Using ROC analysis PCA3 outperformed prostate specific antigen in the prediction of prostate cancer (AUC 0.697 vs 0.599, p<0.01) but not for high grade prostate cancer (AUC 0.682 vs 0.679, p=0.702).
  
  
  CONCLUSIONS
  PCA3 proved a useful tool in identifying patients at risk for prostate cancer before initial prostate biopsy. To our knowledge this is the largest PCA3 study in the initial biopsy population. These results suggest that further exploration of the value of PCA3 is warranted.
authors: Department of Urology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York; Western New York Urology Associates, LLC, Cheektowaga, New York.
authors: K Kent
authors: KK
authors: Chevli
authors: Department of Urology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York; Western New York Urology Associates, LLC, Cheektowaga, New York. Electronic address: mduff@cancercarewny.com.
authors: Michael
authors: M
authors: Duff
authors: Department of Urology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York; Western New York Urology Associates, LLC, Cheektowaga, New York.
authors: Peter
authors: P
authors: Walter
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors: Changhong
authors: C
authors: Yu
authors: Department of Urology, Cleveland Clinic, Cleveland, Ohio.
authors: Brian
authors: B
authors: Capuder
authors: Department of Urology, Cleveland Clinic, Cleveland, Ohio.
authors: Ahmed
authors: A
authors: Elshafei
authors: Department of Urology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York; Western New York Urology Associates, LLC, Cheektowaga, New York.
authors: Stephanie
authors: S
authors: Malczewski
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors: Michael W
authors: MW
authors: Kattan
authors: Department of Urology, Cleveland Clinic, Cleveland, Ohio.
authors: J Stephen
authors: JS
authors: Jones
mesh_terms: D000368:Aged; D000951:Antigens, Neoplasm / Q000652:urine*; D014408:Biomarkers, Tumor / Q000652:urine; D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods*; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000652:urine*; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C479341:prostate cancer antigen 3, human
keywords: human; prostate cancer antigen 3; prostate-specific antigen; prostatic neoplasms