Prostate- specific antigen (PSA) has decreased performance characteristics for detection of prostate cancer (PCa) in African Americans (AA). We sought to evaluate urinary PCA3 and TMPRSS2:ERG in a racially diverse group of men.
Following Institutional Review Board approval, post exam urine was prospectively collected prior to prostate biopsy. PCA3 and TMPRSS2:ERG RNA copies were quantified using transcription-mediated amplification assays (Hologic, San Diego,CA). Prediction models were created using standard of care (SOC) variables (age, race, family history, prior biopsy, abnormal DRE) plus PSA. Decision Curve Analysis (DCA) was performed to compare the net benefit of PCA3 and TMPRSS2:ERG.
Of 304 patients, 182 (60%) were AA; 139 (46%) were diagnosed with PCa (69% AA). PCA3 and TMPRSS2:ERG scores were greater in men with PCa, ≥3 cores, ≥33.3% cores, >50% involvement of greatest biopsy core and Epstein significant PCa (p-values < 0.01). PCA3 added to the SOC+PSA model for the detection of any PCa in the overall cohort (0.747 vs 0.677; p<0.0001), in AA only (0.711 vs 0.638; p=0.0002) and non-AA (0.781 vs 0.732; p=0.0016). PCA3 added to the model for prediction of high-grade PCa for the overall cohort (0.804 vs 0.78; p=0.0002) and AA only (0.759 vs 0.717; p=0.0003), but not non-AA. DCA demonstrated improvement with addition of PCA3. For AA, TMPRSS2:ERG did not improve concordance statistics for PCa detection.
For AA, urinary PCA3 improves the ability to predict the presence of any and high-grade PCa, however the TMPRSS2:ERG urinary assay does not add significantly to standard tools.
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weblog.maimonides.edu/farmacia/archives/UM_Informe_Autoevaluacion_FyB.pdf - //
weblog.maimonides.edu/farmacia/archives/0216_Admin_FarmEcon.pdf - //
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