Journal Article

Longitudinal assessment of urinary PCA3 for predicting prostate cancer grade reclassification in favorable-risk men during active surveillance

Carter, H B, Sokoll, L J, Elliott, D J, Pavlovich, C P, Wolf, S, Epstein, J I, Landis, P, Ross, A E, Tosoian, J J, Patel, H D, Mamawala, M

2017

Overview

Background: To assess the utility of urinary prostate cancer antigen 3 (PCA3) as both a one-time and longitudinal measure in men on active surveillance (AS). Methods: The Johns Hopkins AS program monitors men with favorable-risk prostate cancer with serial PSA, digital rectal examination (DRE), prostate magnetic resonance imaging and prostate biopsy. Since 2007, post-DRE urinary specimens have also been routinely obtained. Men with multiple PCA3 measures obtained over ⩾3 years of monitoring were included. Utility of first PCA3 score (fPCA3), subsequent PCA3 (sPCA3) and change in PCA3 were assessed for prediction of Gleason grade reclassification (GR, Gleason score >6) during follow-up. Results: In total, 260 men met study criteria. Median time from enrollment to fPCA3 was 2 years (interquartile range (IQR) 1–3) and from fPCA3 to sPCA3 was 5 years (IQR 4–6). During median follow-up of 6 years (IQR 5–8), 28 men (11%) underwent GR. Men with GR had higher median fPCA3 (48.0 vs 24.5, P =0.007) and sPCA3 (63.5 vs 36.0, P =0.002) than those without GR, while longitudinal change in PCA3 did not differ by GR status (log-normalized rate 0.07 vs 0.06, P =0.53). In a multivariable model including age, risk classification and PSA density, fPCA3 remained significantly associated with GR (log(fPCA3) odds ratio=1.77, P =0.04). Conclusions: PCA3 scores obtained during AS were higher in men who underwent GR, but the rate of change in PCA3 over time did not differ by GR status. PCA3 was a significant predictor of GR in a multivariable model including conventional risk factors, suggesting that PCA3 provides incremental prognostic information in the AS setting.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 631/67/589/466 / 692/53/2423 / Aged / Antigens / Antigens, Neoplasm - urine / Biomedical and Life Sciences / Biomedicine / Biopsy / Cancer Research / Care and treatment / Classification / Development and progression / Digital imaging / Early Detection of Cancer / Genetic aspects / Health aspects / Humans / Longitudinal Studies / Magnetic Resonance Imaging / Male / Mathematical models / Men / Methods / Middle Aged / Multivariate Analysis / Neoplasm Grading / original-article / Predictions / Prostate cancer / Prostatic Neoplasms - diagnostic imaging / Prostatic Neoplasms - urine / Quality / Reclassification / Rectum / Risk analysis / Risk Factors / Sentinel surveillance / Surveillance / Time measurement / Tumor antigens