The Use of PCA3 Can Reduce the Number of Prostate Biopsies Performed in a Community-Based Urologic Practice

Copyright © 2013 Bradley M. Boelkins et al. This is an open access article distributed under the Creative Commons Attribution Li-cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose: It is now generally accepted that PSA screening identifies many prostate cancers that are low-risk and may not need treatment. PCA3 is a prostate cancer-specific marker with improved diagnostic accuracy when compared with PSA in research studies. It remains unknown whether PCA3 testing can reduce the unnecessary diagnosis and treatment of prostate cancer in routine practice. We evaluated whether the use of PCA3 in clinical practice decreases the number of biopsies being performed in response to PSA testing. Methods: 64 consecutive patients undergoing PCA3 measure-ment in a single community-based urology practice were analyzed for rates of biopsy performance and prostate cancer detection. Results: Median PSA was 5.0 (range: 0.4- 38.6) and 50 % had undergone prior biopsy without evidence of cancer. Median PCA3 score was 13.6 (range: 1.6- 133.0) with 14 patients having an elevated PCA3 (>35). Prostate biopsy was avoided in 50 of 64 patients (78%). Of the 11 patients undergoing biopsy for abnormal PCA3, 7 had pros-tate cancer (64%). At>2-year median follow-up, 39 of the remaining 50 patients (78%) avoided subsequent biopsy. Only 5 prostate cancers were diagnosed during follow-up. Conclusions: When used in routine clinical practice, PCA3 appears to reduce the number of biopsies being performed in response to elevated PSA. Given the increasing interest i