PCA3 as a second-line biomarker in a prospective controlled randomized opportunistic prostate cancer screening programme.
OBJECTIVE
PCA3 performance as a single second line biomarker is compared to the European Randomised Study of Screening for Prostate Cancer risk calculator model 3 (ERSPC RC-3) in an opportunistic screening in prostate cancer (PCa).


METHODS
5,199 men, aged 40-75y, underwent prostate-specific antigen (PSA) screening and digital rectal examination (DRE). Men with a normal DRE and PSA ≥3ng/ml had a PCA3 test done. All men with PCA3 ≥35 underwent an initial biopsy (IBx) -12 cores-. Men with PCA3 <35 were randomized 1:1 to either IBx or observation. We compared them to those obtained with ERSPC RC-3.


RESULTS
PCA3 test was performed on 838 men (16.1%). In PCA3(+) and PCA3(-) groups, global PCa detection rates were 40.9% and 14.7% with a median follow-up (FU) of 21.7 months (P<.001). In the PCA3(+) arm (n=301, 35.9%), PCa was identified in 115 men at IBx (38.2%). In the randomized arm, 256 underwent IBx and PCa was found in 46 (18.0%) (P<.001). The biopsy-sparing potential would have been 64.1% as opposed to 76.6% if we had used ERSPC RC-3. However, the estimated false negative cases for HGPCa would have been reduced by 37.1% (89 to 56 patients). Moreover, if we had applied PCA3-35 to avoid IBx, 14.7% PCa and 9.1% of clinical significant PCa patients would not have been diagnosed during this FU.


CONCLUSIONS
When PCA3-35 is used as a second-line biomarker when PSA ≥3ng/ml and DRE is normal, IBx could be avoided in 12.5% less than if ERSPC RC-3 is used and would reduce the false negative cases by 36.2%. At a FU of 21.7 months, this dual protocol would miss 9.1% of clinically significant PCa, so strict FU is mandatory with established biopsy criteria based on PSA and DRE in cases with PCA3 <35.
Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España. Electronic address: urologia@fivo.org.
J
J
Rubio-Briones
Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España.
J
J
Casanova
Departamento de Estadística, Universidad de Valencia, Valencia, España.
F
F
Martínez
Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España.
J L
JL
Domínguez-Escrig
Biología Molecular, Fundación Instituto Valenciano de Oncología, Valencia, España.
A
A
Fernández-Serra
Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España.
R
R
Dumont
Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España.
M
M
Ramírez-Backhaus
Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España.
A
A
Gómez-Ferrer
Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, España.
A
A
Collado
Biología Molecular, Fundación Instituto Valenciano de Oncología, Valencia, España.
L
L
Rubio
Fundación para el Fomento de la Investigación Sanitaria y Biomédica en la Comunitat Valenciana (FISABIO-Salud Pública), Valencia, España.
A
A
Molina
Fundación para el Fomento de la Investigación Sanitaria y Biomédica en la Comunitat Valenciana (FISABIO-Salud Pública), Valencia, España.
M
M
Vanaclocha
Fundación para el Fomento de la Investigación Sanitaria y Biomédica en la Comunitat Valenciana (FISABIO-Salud Pública), Valencia, España.
D
D
Sala
Biología Molecular, Fundación Instituto Valenciano de Oncología, Valencia, España.
J A
JA
Lopez-Guerrero
D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000652:urine*; D014408:Biomarkers, Tumor / Q000652:urine*; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000652:urine*
D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; C479341:prostate cancer antigen 3, human
Cribado oportunista; Cáncer de próstata; Opportunistic screening; PCA3; PSA; Prostate cancer