Optimizing the clinical utility of PCA3 to diagnose prostate cancer in initial prostate biopsyReport as inadecuate




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BMC Cancer

, 15:633

First Online: 11 September 2015Received: 21 April 2015Accepted: 21 August 2015DOI: 10.1186-s12885-015-1623-0

Cite this article as: Rubio-Briones, J., Borque, A., Esteban, L.M. et al. BMC Cancer 2015 15: 633. doi:10.1186-s12885-015-1623-0

Abstract

BackgroundPCA3 has been included in a nomogram outperforming previous clinical models for the prediction of any prostate cancer PCa and high grade PCa HGPCa at the initial prostate biopsy IBx. Our objective is to validate such IBx-specific PCA3-based nomogram. We also aim to optimize the use of this nomogram in clinical practice through the definition of risk groups.

MethodsIndependent external validation. Clinical and biopsy data from a contemporary cohort of 401 men with the same inclusion criteria to those used to build up the reference’s nomogram in IBx. The predictive value of the nomogram was assessed by means of calibration curves and discrimination ability through the area under the curve AUC. Clinical utility of the nomogram was analyzed by choosing thresholds points that minimize the overlapping between probability density functions PDF in PCa and no PCa and HGPCa and no HGPCa groups, and net benefit was assessed by decision curves.

ResultsWe detect 28 % of PCa and 11 % of HGPCa in IBx, contrasting to the 46 and 20 % at the reference series. Due to this, there is an overestimation of the nomogram probabilities shown in the calibration curve for PCa. The AUC values are 0.736 for PCa C.I.95 %:0.68–0.79 and 0.786 for HGPCa C.I.95 %:0.71–0.87 showing an adequate discrimination ability. PDF show differences in the distributions of nomogram probabilities in PCa and not PCa patient groups. A minimization of the overlapping between these curves confirms the threshold probability of harboring PCa >30 % proposed by Hansen is useful to indicate a IBx, but a cut-off > 40 % could be better in series of opportunistic screening like ours. Similar results appear in HGPCa analysis. The decision curve also shows a net benefit of 6.31 % for the threshold probability of 40 %.

ConclusionsPCA3 is an useful tool to select patients for IBx. Patients with a calculated probability of having PCa over 40 % should be counseled to undergo an IBx if opportunistic screening is required.

AbbreviationsAUCArea under the curve

BxProstatic biopsy

CIConfidence interval

FDAFood and drug administration

DREDigital rectal examination

HG-PCaHigh-grade PCa

IBxInitial prostate biopsy

IVOInstituto Valenciano de Oncología

IQRInterquartile ranges

PCaProstate cancer

PCA3The Prostate CAncer gene 3

PDFProbability density functions

PSAProstatic specific antigen

TRUSTransrectal ultrasound

ROCReceiver operating characteristics

USAUnited States of America

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Author: Jose Rubio-Briones - Angel Borque - Luis M. Esteban - Juan Casanova - Antonio Fernandez-Serra - Luis Rubio - Irene Casanov

Source: https://link.springer.com/







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