World Journal of Urology

, Volume 34, Issue 4, pp 509–515 | Cite as

Prostate cancer gene 3 (PCA3) is of additional predictive value in patients with PI-RADS grade III (intermediate) lesions in the MR-guided re-biopsy setting for prostate cancer

  • S. KaufmannEmail author
  • J. BedkeEmail author
  • S. Gatidis
  • J. Hennenlotter
  • U. Kramer
  • M. Notohamiprodjo
  • K. Nikolaou
  • A. Stenzl
  • S. Kruck
Original Article



Multiparametric magnetic resonance imaging (mpMRI) improves diagnostic accuracy in re-biopsies of men with prostate cancer (PC) suspicion, but predictive value is limited despite the use of the new Prostate Imaging Reporting and Data System (PI-RADS). Prognostic value of the PC-specific biomarker prostate cancer gene 3 (PCA3) added to the PI-RADS score was evaluated.


The study was a retrospective analysis of the institutional database for men with MR-guided biopsy (MR-GB) for suspicious lesion in mpMRI and who had an additional pre-MR-GB PCA3 testing for ongoing PC suspicion. All men had ≥1 negative ultrasound GB. Lesions were retrospectively scored by PI-RADS in three MRI sequences (T2w, DCE, and DWI). PCA3 was analyzed with cutoffs of 25 and 35. The prognostic value of mpMRI and PCA3 and the additional value of both were explored.


Tumor detection rate (49 men, mean PSA 10 ng/ml, lesion size 40 mm2) was 45 % (22/49 patients). In the subgroup of PI-RADS IV°, 17/17 patients had PC; in PI-RADS III° (intermediate) 5/15 had PC, and all 5 had a PCA3 >35. PCA3 >35 had no additional prognostic value in the whole cohort. Out of the 10/15 PC negative patients (PI-RADS III°), PCA3 was <35 in 6. The inclusion of PCA3 value in PI-RADS III° patients improved predictive accuracy to 91.8 %.


MpMRI and subsequent grading to PI-RADS significantly improves PC detection in the re-biopsy setting. The diagnostic uncertainty in the PI-RADS intermediate group can be ameliorated by the addition of PCA3 cutoff of 35 to avoid potential unnecessary biopsies.


Prostate cancer PCA3 PI-RADS MRI MR-guided biopsy Targeted prostate biopsy 



Waltraud Mogk is kindly acknowledged for excellent technical assistance and Jessica Kaufmann for linguistic editing.

Author contribution

Protocol/project development: Kaufmann S, Bedke J, Kruck S, Hennenlotter J. Data collection or management: Kaufmann S, Kramer U, and Hennenlotter J. Data analysis: Kaufmann S, Gatidis S. Manuscript writing: Kaufmann S, Bedke J, Kruck S. Manuscript editing: Kaufmann S, Bedke J, Gatidis S, Hennenlotter J, Kramer U, Notohamiprodjo M, Nikolaou K, Stenzl A, Kruck S. Study Supervision: Bedke J, Kruck S.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Ethical standard

This analysis was approved by the institutional review board (397/2012R) of the University of Tübingen, Germany.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyEberhard Karls University TuebingenTuebingenGermany
  2. 2.Department of UrologyEberhard Karls University TuebingenTuebingenGermany

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