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Age-specific PCA3 score reference values for diagnosis of prostate cancer

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Abstract

Purpose

We evaluated the impact of age on PCA3 score and the utility of age-specific reference values in predicting initial prostate biopsy (pBx) outcomes.

Patients and methods

This single-center, retrospective study included 205 men who underwent an initial 14-core TRUS-guided pBx due to PSA > 3.0 ng/ml or suspicious digital-rectal examination (DRE). PCA3 scores were measured with the Progensa assay. Linear regression models were fit to identify factors that impact PCA3 score and to determine age-specific reference values. Predictive accuracies of logistic regression models predicting presence of prostate cancer (PCa) were analyzed.

Results

The positive biopsy rate was 37%. In multivariable linear regression, age (P < 0.001), presence of PCa (P < 0.001), and multifocal HG-PIN (P = 0.012) were independent predictors of PCA3 score. Age showed the strongest impact on PCA3 score (T = 4.77). The upper 95% confidence interval of PCA3 score in each age category was defined as the age-specific limit. A PCA3-score over the age-specific limit (PCA3-age) was associated with an 4.17-fold increased odds of being diagnosed with PCa (P < 0.001). In multivariable logistic regression models predicting the presence of PCa, predictive accuracy of a base model (age, DRE, PSA, volume) increased from 69.6 to 75.4% (P = 0.037) by adding the continuous PCA3 score, to 73.9% (P = 0.098) with the 35 cutoff (PCA3-35) and to 77.1% (P = 0.008) with PCA3-age.

Conclusions

PCA3 score increases with age, independent of PCa presence. Age-specific PCA3 score reference values are superior to PSA, continuous PCA3 score, and PCA3-35 in predicting initial pBx outcome. Therefore, an age-adjusted PCA3 score should be used for interpretation of the results.

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Conflict of interest

The authors declare that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, Medical University of Vienna, Vienna, Austria

    Tobias Klatte, Matthias Waldert, Michela de Martino & Georg Schatzl

  2. Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria

    Christine Mannhalter

  3. Department of Urology, Landesklinikum Weinviertel, Wiener Ring 3–5, 2100, Korneuburg, Austria

    Mesut Remzi

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  1. Tobias Klatte
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  2. Matthias Waldert
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  3. Michela de Martino
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  4. Georg Schatzl
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  5. Christine Mannhalter
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  6. Mesut Remzi
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Correspondence to Mesut Remzi.

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Klatte, T., Waldert, M., de Martino, M. et al. Age-specific PCA3 score reference values for diagnosis of prostate cancer. World J Urol 30, 405–410 (2012). https://doi.org/10.1007/s00345-011-0749-1

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  • DOI: https://doi.org/10.1007/s00345-011-0749-1

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