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BJU Int. 2016 Nov;118(5):723-730. doi: 10.1111/bju.13504. Epub 2016 May 24.

High prostate cancer gene 3 (PCA3) scores are associated with elevated Prostate Imaging Reporting and Data System (PI-RADS) grade and biopsy Gleason score, at magnetic resonance imaging/ultrasonography fusion software-based targeted prostate biopsy after a previous negative standard biopsy.

Author information

1
Department of Urology, San Luigi Gonzaga Hospital, University of Torino, Orbassano, Italy. delucastefano@yahoo.it.
2
Department of Nuclear Medicine, San Giovanni Battista Hospital, University of Torino, Torino, Italy.
3
Department of Urology, San Luigi Gonzaga Hospital, University of Torino, Orbassano, Italy.
4
Department of Pathology, San Luigi Gonzaga Hospital, University of Torino, Orbassano, Italy.
5
Department of Radiology, Mauriziano Hospital, Torino, Italy.

Abstract

OBJECTIVE:

To determine the association among prostate cancer gene 3 (PCA3) score, Prostate Imaging Reporting and Data System (PI-RADS) grade and Gleason score, in a cohort of patients with elevated prostate-specific antigen (PSA), undergoing magnetic resonance imaging/ultrasonography fusion software-based targeted prostate biopsy (TBx) after a previous negative randomised 'standard' biopsy (SBx).

PATIENTS AND METHODS:

In all, 282 patients who underwent TBx after previous negative SBx and a PCA3 urine assay, were enrolled. The associations between PCA3 score/PI-RADS and PCA3 score/Gleason score were investigated by K-means clustering, a receiver operating characteristic analysis and binary logistic regression.

RESULTS:

The PCA3 score difference for the negative vs positive TBx cohorts was highly statistically significant. A 1-unit increase in the PCA3 score was associated to a 2.4% increased risk of having a positive TBx result. A PCA3 score of >80 and a PI-RADS grade of ≥4 were independent predictors of a positive TBx. The association between the PCA3 score and PI-RADS grade was statistically significant (the median PCA3 score for PI-RADS grade groups 3, 4, and 5 was 58, 104, and 146, respectively; P = 0.006). A similar pattern was detected for the relationship between the PCA3 score and Gleason score; an increasing PCA3 score was associated with a worsening Gleason score (median PCA3 score equal to 62, 105, 132, 153, 203, and 322 for Gleason Score 3+4, 4+3, 4+4, 4+5, 5+4, and 5+5, respectively; P < 0.001).

CONCLUSION:

TBx improved PCA3 score diagnostic and prognostic performance for prostate cancer. The PCA3 score was directly associated both with biopsy Gleason score and PI-RADS grade: notably, in the 'indeterminate' PI-RADS grade 3 subgroup.

KEYWORDS:

magnetic resonance imaging; prostate cancer; prostate cancer antigen 3 gene; targeted prostate biopsy

PMID:
27112799
DOI:
10.1111/bju.13504
[Indexed for MEDLINE]
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