The Journal of Urology
Volume 180, Issue 5 , Pages 1975-1979, November 2008

PCA3 Score Before Radical Prostatectomy Predicts Extracapsular Extension and Tumor Volume

Urology Service, Walter Reed Army Medical Center (EJW, SB, DGM) and Department of Genito-Urinary Pathology, Armed Forces Institute of Pathology (IAS, BF), Washington, D. C., Center for Prostate Disease Research (EJW, AA, YC, BF, GP, MI, SE, JC, SS, DGM), Department of Surgery, Uniformed Services University (GP, SB, SS, DGM), Bethesda, Maryland, and Gen-Probe, Inc., San Diego, California

Received 27 March 2008 published online 17 September 2008.

Purpose

PCA3 is a prostate specific, nonprotein coding RNA that is over expressed in prostate cancer. Recent studies showed the diagnostic potential of a urine based PCA3 for predicting biopsy outcome. We assessed the relationship between urine PCA3 and pathological features in whole mount radical prostatectomy specimens.

Materials and Methods

Post-digital rectal examination urine specimens were obtained from 72 men with prostate cancer before radical prostatectomy. PCA3 and PSA mRNA were measured. The ratio of PCA3 to PSA mRNA was recorded as a PCA3 score and correlated with data on each prostate specimen.

Results

Patients with extracapsular extension had a significantly higher median PCA3 score than patients without extracapsular extension (48.8 vs 18.7, p = 0.02). PCA3 score significantly correlated with total tumor volume (r = 0.38, p <0.01). On multivariate analysis PCA3 score was an independent predictor of extracapsular extension (p = 0.01) and total tumor volume less than 0.5 cc (p = 0.04). At a cutoff PCA3 score of 47 extracapsular extension was predicted with 94% specificity and an 80% positive predictive value. When combined with serum PSA and biopsy Gleason score, the ROC AUC for predicting extracapsular extension was 0.90.

Conclusions

PCA3 detected in the post-digital rectal examination urine of patients with prostate cancer correlated with pathological findings. Therefore, it could provide prognostic information. To our knowledge this is the first report of a molecular urine assay that predicts extracapsular extension.

Key Words: prostate, prostatic neoplasms, urine, tumor marker, biological, gene expression

Abbreviations and Acronyms: CaP, prostate cancer, ECE, extracapsular extension, DRE, digital rectal examination, GS, Gleason score, LR, logistic regression, PCA3, CaP gene 3, PSA, prostate specific antigen

 

 Study received institutional review board approval.

 Supported by a grant from Gen-Probe, Inc., San Diego, California (DGM, SS).

 For another article on a related topic see page 2206.

PII: S0022-5347(08)01863-6

doi:10.1016/j.juro.2008.07.060

Refers to article:

  • The Significance of Monoamine Oxidase-A Expression in High Grade Prostate Cancer , 22 September 2008

    Donna M. Peehl, Marc Coram, Htet Khine, Stephen Reese, Rosalie Nolley, Hongjuan Zhao
    The Journal of Urology November 2008 (Vol. 180, Issue 5, Pages 2206-2211)

The Journal of Urology
Volume 180, Issue 5 , Pages 1975-1979, November 2008