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Abstract
Objective. The aim of this study was to test the ability of prostate cancer antigen-3 (PCA3) and Hansen’s PCA3-based nomogram to predict prostate cancer (PCa) probability in a Norwegian cohort, with the goal of reducing unnecessary biopsies. Material and methods. Altogether, 127 consecutive patients were recruited to this study at Haukeland University Hospital, Norway. Prostate-specific antigen (PSA), PCA3 score, digital rectal examination (DRE), prostate volume (Pvol) and age were determined. All patients had an extended 10-core biopsy. The performance of PCA3 score and Hansen’s nomogram was tested. Results. There were 124 evaluable patients. Among these, 59 patients had PCa on the initial biopsies. Mean PSA, PCA3 score and age were significantly higher and Pvol was significantly lower in patients with PCa. PCA3 scores of 35 and 21 led to a sensitivity of 71% and 81% and specificity of 72% and 55%, respectively. Hansen’s nomogram gave an area under the curve (AUC) of 0.806. The intraclass correlation was 0.959 (Cronbach’s alpha). Applied to this material, PCa would be missed in 15.2% of patients when applying the suggested threshold probability of 30%, among whom 66.7% had high-grade PCa. With a threshold probability of 20% only one patient had PCa and this was low grade. Conclusions. Hansen’s PCA3-based nomogram is valid for this cohort. A threshold probability of 20% seems more adequate than 30% for this less screened cohort. PCA3 score only affects the biopsy indication in some patients and is recommended only for this subset. The results need to be confirmed in a larger study.
Acknowledgements
We would like to thank Felix Chun and Jens Hansen, two of the authors of Hansen’s nomogram, for supplying us with the coefficients for calculating the predicted probability of prostate cancer according to their nomogram applied to this cohort. Furthermore, special thanks goes to Amir Moghaddam at Fürst Medical Laboratory for performing the PCA3 analyses.
Declaration of interest: The authors have nothing to disclose. The study was carried out with funding from the institutions mentioned on the title page and by a grant from the URO-BERGEN research foundation. Fürst Medical Laboratory in Oslo performed the PCA3 analyses at a reduced price since the results were used in a study setting. The authors alone are responsible for the content and writing of the paper.