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Clinical Research

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

Prostate Cancer and Prostatic Diseases volume 20, pages 339–342 (2017)Cite this article

Subjects

Abstract

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.

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Acknowledgements

Reagent support for PCA3 was provided by Hologic. This project was supported by grant NCI U24CA115102 from the National Cancer Institute of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

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

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  1. J J Tosoian
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  2. H D Patel
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  3. M Mamawala
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  4. P Landis
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  6. D J Elliott
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  7. J I Epstein
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  8. H B Carter
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  9. A E Ross
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  10. L J Sokoll
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Correspondence to H D Patel.

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The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on the Prostate Cancer and Prostatic Diseases website

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Tosoian, J., Patel, H., Mamawala, M. et al. Longitudinal assessment of urinary PCA3 for predicting prostate cancer grade reclassification in favorable-risk men during active surveillance. Prostate Cancer Prostatic Dis 20, 339–342 (2017). https://doi.org/10.1038/pcan.2017.16

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