World Journal of Urology

, Volume 30, Issue 2, pp 251–256

Biopsy and treatment decisions in the initial management of prostate cancer and the role of PCA3; a systematic analysis of expert opinion

  • Bertrand Tombal
  • Filip Ameye
  • Alexandre de la Taille
  • Theo de Reijke
  • Paolo Gontero
  • Alexander Haese
  • Paul Kil
  • Paul Perrin
  • Mesut Remzi
  • Jörg Schröder
  • Mark Speakman
  • Alessandro Volpe
  • Bianca Meesen
  • Herman Stoevelaar
Original Article

DOI: 10.1007/s00345-011-0721-0

Cite this article as:
Tombal, B., Ameye, F., de la Taille, A. et al. World J Urol (2012) 30: 251. doi:10.1007/s00345-011-0721-0

Abstract

Purpose

The Prostate CAncer gene 3 (PCA3) assay may guide prostate biopsy decisions and predict prostate cancer (PCa) aggressiveness. This study explored the appropriateness of (1) PCA3 testing; (2) biopsy; (3) active surveillance (AS) and the value of the PCA3 Score for biopsy and AS decisions.

Methods

Using the RAND/UCLA appropriateness method, 12 urologists assessed the appropriateness of PCA3, biopsy and AS for theoretical patient profiles, constructed by combining clinical variables. They individually scored the appropriateness for all profiles using a 9-point scale. Based on the median score and extent of agreement, the appropriateness for each profile was calculated.

Results

The PCA3 Assay was mainly considered appropriate in men with ≥1 negative biopsy, PSA ≥ 3 ng/mL and life expectancy (LE) ≥10 years. A LE < 10 years, ≥2 negative biopsies and PCA3 Score <20 decreased biopsy appropriateness, while PSA ≥ 3 ng/mL and PCA3 Score >50 increased it. In men without a prior biopsy, LE ≥ 10 years and a suspicious DRE, PCA3 did not affect biopsy appropriateness. In other men, a PCA3 Score <20 discouraged biopsy, while a value ≥35 supported biopsy. AS was mainly considered appropriate if LE < 10 years, T1c PCa, ≤20% positive cores and PSA < 3 ng/mL. A PCA3 Score <20 pleads for and higher scores (particularly >50) against AS.

Conclusions

These findings illustrate in which men PCA3 can be of additional value when taking biopsy and treatment decisions in clinical practice.

Keywords

Active surveillanceBiopsyExpertOpinionPCA3RAND appropriateness method

Supplementary material

345_2011_721_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 kb)
345_2011_721_MOESM2_ESM.pdf (6.1 mb)
Patient profiles (PDF 6196 kb)
345_2011_721_MOESM3_ESM.pdf (562 kb)
Literature Review: Initial Management of Prostate Cancer (PDF 561 kb)

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Bertrand Tombal
    • 1
  • Filip Ameye
    • 2
  • Alexandre de la Taille
    • 3
  • Theo de Reijke
    • 4
  • Paolo Gontero
    • 5
  • Alexander Haese
    • 6
  • Paul Kil
    • 7
  • Paul Perrin
    • 8
  • Mesut Remzi
    • 9
  • Jörg Schröder
    • 10
  • Mark Speakman
    • 11
  • Alessandro Volpe
    • 12
  • Bianca Meesen
    • 13
  • Herman Stoevelaar
    • 13
  1. 1.Service d’UrologieCliniques Universitaires Saint-Luc UCLBruxellesBelgium
  2. 2.UZ GasthuisbergLeuvenBelgium
  3. 3.Hôpital Henri MondorCréteilFrance
  4. 4.Academic Medical CenterAmsterdamThe Netherlands
  5. 5.Ospedale MolinetteUniversità di TorinoTurinItaly
  6. 6.Martini Clinic Prostate Cancer CenterUniversity Clinic EppendorfHamburgGermany
  7. 7.St. Elisabeth ZiekenhuisTilburgThe Netherlands
  8. 8.Hôpital Henry GabrielleLyonFrance
  9. 9.Medical University of ViennaViennaAustria
  10. 10.ATURO Uroonkologische GemeinschaftspraxisBerlinGermany
  11. 11.Taunton and Somerset HospitalTauntonUK
  12. 12.Maggiore della Carità HospitalNovaraItaly
  13. 13.Ismar Healthcare NVLierBelgium