title: Risk Stratification by Urinary Prostate Cancer Gene 3 Testing Before Magnetic Resonance Imaging-Ultrasound Fusion-targeted Prostate Biopsy Among Men With No History of Biopsy.
abstract: OBJECTIVE
  To determine whether a combination of prostate cancer gene 3 (PCA3) and magnetic resonance imaging (MRI) suspicion score (mSS) could further optimize detection of prostate cancer on MRI fusion-targeted biopsy (MRF-TB) among men with no history of biopsy.
  
  
  METHODS
  We included in this study 187 men presenting to our institution between June 2012 and August 2014 who underwent multiparametric MRI (mpMRI) and PCA3 before MRF-TB. Biopsy results, stratified by biopsy indication and PCA3 score, were recorded. Receiver operating characteristics curves and multivariable logistic regressions were used to model the association of PCA3 and mSS with cancer detection on MRF-TB.
  
  
  RESULTS
  PCA3 is associated with cancer detection on MRF-TB for men with no prior biopsies (area under the curve: 0.67, 95% confidence interval: 0.59-0.76). Using a cutoff of ≥35, PCA3 was associated with cancer risk among men with mSS 2-3 (P = .004), but not among those with mSS 4-5 (P = .340). The interaction of PCA3 and mSS demonstrated significantly higher discrimination for cancer than mSS alone (area under the curve: 0.83 vs 0.79, P = .0434).
  
  
  CONCLUSIONS
  Urinary PCA3 is associated with mSS and the detection of cancer on MRF-TB for men with no prior biopsies. PCA3 notably demonstrates a high negative predictive value among mSS 2-3. However, in the case of high-suspicion mpMRI, PCA3 is not associated with cancer detection on MRF-TB, adding little to cancer diagnosis. Further studies are needed to evaluate the utility of PCA3 in predicting cancer among men with normal mpMRI.
authors: School of Medicine, NYU Langone Medical Center, New York, NY.
authors: Michael
authors: M
authors: Fenstermaker
authors: School of Medicine, NYU Langone Medical Center, New York, NY.
authors: Neil
authors: N
authors: Mendhiratta
authors: Department of Urology, NYU Langone Medical Center, New York, NY.
authors: Marc A
authors: MA
authors: Bjurlin
authors: Department of Urology, NYU Langone Medical Center, New York, NY.
authors: Xiaosong
authors: X
authors: Meng
authors: Department of Radiology, NYU Langone Medical Center, New York, NY.
authors: Andrew B
authors: AB
authors: Rosenkrantz
authors: Department of Urology, NYU Langone Medical Center, New York, NY.
authors: Richard
authors: R
authors: Huang
authors: Department of Pathology, NYU Langone Medical Center, New York, NY.
authors: Fang-Ming
authors: FM
authors: Deng
authors: Department of Pathology, NYU Langone Medical Center, New York, NY.
authors: Ming
authors: M
authors: Zhou
authors: Department of Urology, NYU Langone Medical Center, New York, NY.
authors: William C
authors: WC
authors: Huang
authors: Department of Urology, NYU Langone Medical Center, New York, NY.
authors: Herbert
authors: H
authors: Lepor
authors: Department of Urology, NYU Langone Medical Center, New York, NY; Department of Radiology, NYU Langone Medical Center, New York, NY. Electronic address: samir.taneja@nyumc.org.
authors: Samir S
authors: SS
authors: Taneja
mesh_terms: D000951:Antigens, Neoplasm / Q000652:urine*; D014408:Biomarkers, Tumor / Q000652:urine; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D015994:Incidence; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D009518:New York / Q000453:epidemiology; D011237:Predictive Value of Tests; D011467:Prostate / Q000000981:diagnostic imaging*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C479341:prostate cancer antigen 3, human