Prostate cancer gene 3 (PCA3) is of additional predictive value in patients with PI-RADS grade III (intermediate) lesions in the MR-guided re-biopsy setting for prostate cancer.
OBJECTIVE
Multiparametric magnetic resonance imaging (mpMRI) improves diagnostic accuracy in re-biopsies of men with prostate cancer (PC) suspicion, but predictive value is limited despite the use of the new Prostate Imaging Reporting and Data System (PI-RADS). Prognostic value of the PC-specific biomarker prostate cancer gene 3 (PCA3) added to the PI-RADS score was evaluated.


METHODS
The study was a retrospective analysis of the institutional database for men with MR-guided biopsy (MR-GB) for suspicious lesion in mpMRI and who had an additional pre-MR-GB PCA3 testing for ongoing PC suspicion. All men had ≥ 1 negative ultrasound GB. Lesions were retrospectively scored by PI-RADS in three MRI sequences (T2w, DCE, and DWI). PCA3 was analyzed with cutoffs of 25 and 35. The prognostic value of mpMRI and PCA3 and the additional value of both were explored.


RESULTS
Tumor detection rate (49 men, mean PSA 10 ng/ml, lesion size 40 mm(2)) was 45 % (22/49 patients). In the subgroup of PI-RADS IV°, 17/17 patients had PC; in PI-RADS III° (intermediate) 5/15 had PC, and all 5 had a PCA3 > 35. PCA3 > 35 had no additional prognostic value in the whole cohort. Out of the 10/15 PC negative patients (PI-RADS III°), PCA3 was < 35 in 6. The inclusion of PCA3 value in PI-RADS III° patients improved predictive accuracy to 91.8 %.


CONCLUSIONS
MpMRI and subsequent grading to PI-RADS significantly improves PC detection in the re-biopsy setting. The diagnostic uncertainty in the PI-RADS intermediate group can be ameliorated by the addition of PCA3 cutoff of 35 to avoid potential unnecessary biopsies.
Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany. sascha.kaufmann@med.uni-tuebingen.de.|Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany. sascha.kaufmann@med.uni-tuebingen.de.
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Kaufmann
Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany. bedke@live.com.
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http://orcid.org/0000-0003-2778-3108
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Bedke
Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
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Gatidis
Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
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Hennenlotter
Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
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Kramer
Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
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Notohamiprodjo
Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
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Nikolaou
Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
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Stenzl
Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
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Kruck
D000368:Aged; D000951:Antigens, Neoplasm / Q000235:genetics* / Q000652:urine; D014408:Biomarkers, Tumor / Q000235:genetics / Q000652:urine; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000652:urine; D012334:RNA, Neoplasm / Q000235:genetics*; D012372:ROC Curve; D012189:Retrospective Studies
D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D012334:RNA, Neoplasm; C479341:prostate cancer antigen 3, human
MR-guided biopsy; MRI; PCA3; PI-RADS; Prostate cancer; Targeted prostate biopsy