Evaluation of PCA3 and multiparametric MRI's: collective benefits before deciding initial prostate biopsy for patients with PSA level between 3-10ng/mL.
OBJECTIVE
To analyze the contribution of multiparametric MRI and PCA3 assay, predecision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE).


METHODS
PSA level 3-10 ng/mL, patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient underwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted. Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated.


RESULTS
53 patients were included between February 2013 and March 2014. Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams. Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3's PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%. NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively.


CONCLUSIONS
Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI.
Department of Urology, Beytepe Military Hospital, Ankara, Turkey.
Sezgin
S
Okcelik
Department of Urology Haydarpasa Training Hospital, Istanbul, Turkey.
Hasan
H
Soydan
Department of Urology Haydarpasa Training Hospital, Istanbul, Turkey.
Ferhat
F
Ates
Department of Pathology, Corlu Military Hospital, Tekirdag, Turkey.
Ufuk
U
Berber
Department of Radiology, Haydarpasa Training Hospital, Istanbul, Turkey.
Hasan
H
Saygin
Department of Radiology, Haydarpasa Training Hospital, Istanbul, Turkey.
Guner
G
Sonmez
Department of Urology Haydarpasa Training Hospital, Istanbul, Turkey.
Kenan
K
Karademir
D000367:Age Factors; D000951:Antigens, Neoplasm / Q000652:urine*; D001706:Biopsy; D000066491:Clinical Decision-Making; D051517:Digital Rectal Examination / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009929:Organ Size; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000652:urine; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment
D000951:Antigens, Neoplasm; C479341:prostate cancer antigen 3, human; D017430:Prostate-Specific Antigen