Biopsy and treatment decisions in the initial management of prostate cancer and the role of PCA3; a systematic analysis of expert opinion

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 a parts per thousand yen1 negative biopsy, PSA a parts per thousand yen 3 ng/mL and life expectancy (LE) a parts per thousand yen10 years. A LE <10 years, a parts per thousand yen2 negative biopsies and PCA3 Score <20 decreased biopsy appropriateness, while PSA a parts per thousand yen 3 ng/mL and PCA3 Score > 50 increased it. In men without a prior biopsy, LE a parts per thousand yen 10 years and a suspicious DRE, PCA3 did not affect biopsy appropriateness. In other men, a PCA3 Score <20 discouraged biopsy, while a value a parts per thousand yen35 supported biopsy. AS was mainly considered appropriate if LE <10 years, T1c PCa, a parts per thousand currency sign20% 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