Introduction

To assess interest of Prostate Cancer Antigen 3 (PCA3) screening in prostate cancer (PCa) diagnostic management after an individual risk assessment.

Methods

From 2011 to 2016, patients with elevated PSA and negative prostate biopsies (PB) were included in an open monocentric prospective study after approval of Institutional review board. Each patient had an urinary PCA3 test to assess the risk of PCa with three different nomograms (Prostate Cancer Prevention Trial Risk Calculator (PCPT), PCPT + PCA3, PCPT 2.0). After consultation, decision to perform biopsy was at urologist discretion. A logistic regression analysis was performed to determine predictive factors (PF) for PCa diagnostic at 12 months and 5 years. Success of screening was defined as positive PB in the first year after consultation or no PCa diagnosed at the end of the follow up. While, failure was defined as negative PB in the first year after consultation or PCa diagnosed more than 12 months after consultation._x000D_

Results

In our study, 516 patients were included with mean age 64.7 (IQR47_85), mean PSA 8.1ng/mL (0.27_119.8), mean PCA3 score 22 (1_533) and 18.9% had suspicious digital rectal examination. At 12 months, 6 PF of success were found: low PSA ratio (p=0.08), low prostatic volume (p<0.01), high PSA density (p<0.01), high PCA3 (p<0.01), high PCPT risk (p=0.04) and high PCPT + PCA3 risk (p<0.01). At 5 years, after primary screening, PCA3 score isolated or integrate in PCPT risk calculator was the only one biological PF of consultation success (PCPT + PCA3 (p<0.01) and PCA3 rates (p<0.01). The rate of success was 46.5% and 94% at 12 months and 5 years respectively after primary screening (figure 1).

Conclusions

In our study, PCA3 was able to reach a high rate of positive biopsy at 12 months and allowed to avoid 94% of prostate biopsy at 5 years.

Funding

none