Service d'Urologie, Cliniques Universitaires Saint-Luc UCL, Avenue Hippocrate, 10, 1200 Bruxelles, Belgium.
World J Urol. 2012 Apr;30(2):251-6. doi: 10.1007/s00345-011-0721-0. Epub 2011 Jul 1.
The Prostate CAncer gene 3 (PCA3) assay may guide prostate biopsy decisions and predict prostate cancer (PCa) aggressiveness. This study explored the appropriateness of (1) PCA3 testing; (2) biopsy; (3) active surveillance (AS) and the value of the PCA3 Score for biopsy and AS decisions.
Using the RAND/UCLA appropriateness method, 12 urologists assessed the appropriateness of PCA3, biopsy and AS for theoretical patient profiles, constructed by combining clinical variables. They individually scored the appropriateness for all profiles using a 9-point scale. Based on the median score and extent of agreement, the appropriateness for each profile was calculated.
The PCA3 Assay was mainly considered appropriate in men with ≥1 negative biopsy, PSA ≥ 3 ng/mL and life expectancy (LE) ≥10 years. A LE < 10 years, ≥2 negative biopsies and PCA3 Score <20 decreased biopsy appropriateness, while PSA ≥ 3 ng/mL and PCA3 Score >50 increased it. In men without a prior biopsy, LE ≥ 10 years and a suspicious DRE, PCA3 did not affect biopsy appropriateness. In other men, a PCA3 Score <20 discouraged biopsy, while a value ≥35 supported biopsy. AS was mainly considered appropriate if LE < 10 years, T1c PCa, ≤20% positive cores and PSA < 3 ng/mL. A PCA3 Score <20 pleads for and higher scores (particularly >50) against AS.
These findings illustrate in which men PCA3 can be of additional value when taking biopsy and treatment decisions in clinical practice.
前列腺癌基因 3（PCA3）检测可辅助前列腺活检决策并预测前列腺癌（PCa）侵袭性。本研究旨在探讨（1）PCA3 检测、（2）活检、（3）主动监测（AS）的适宜性，以及 PCA3 评分在活检和 AS 决策中的价值。
采用 RAND/UCLA 适宜性方法，12 位泌尿科医生根据临床变量组合，对理论患者特征进行 PCA3、活检和 AS 的适宜性评估。他们使用 9 分制对所有特征进行个体评分。根据中位数评分和一致性程度，计算每个特征的适宜性。
PCA3 检测主要适用于（1）既往≥1 次阴性活检、（2）PSA≥3ng/ml 和（3）预期寿命（LE）≥10 年的男性。LE<10 年、≥2 次阴性活检和 PCA3 评分<20 会降低活检的适宜性，而 PSA≥3ng/ml 和 PCA3 评分>50 则会增加其适宜性。对于既往无活检史的男性，LE≥10 年且直肠指检可疑时，PCA3 对活检的适宜性无影响。在其他男性中，PCA3 评分<20 不鼓励活检，而评分≥35 则支持活检。如果 LE<10 年、T1cPCa、≤20%阳性核心和 PSA<3ng/ml，则 AS 主要被认为是适宜的。PCA3 评分<20 支持 AS，评分较高（尤其是>50）则不支持 AS。
这些发现表明，在临床实践中，PCA3 可在男性进行活检和治疗决策时提供额外的价值。
