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Huskova Z, Knillova J, Kolar Z, Vrbkova J, Kral M, Bouchal J. The Percentage of Free PSA and Urinary Markers Distinguish Prostate Cancer from Benign Hyperplasia and Contribute to a More Accurate Indication for Prostate Biopsy. Biomedicines 2020; 8:biomedicines8060173. [PMID: 32630458 PMCID: PMC7344460 DOI: 10.3390/biomedicines8060173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 01/05/2023] Open
Abstract
The main advantage of urinary biomarkers is their noninvasive character and the ability to detect multifocal prostate cancer (CaP). We have previously implemented a quadruplex assay of urinary markers into clinical practice (PCA3, AMACR, TRPM8 and MSMB with KLK3 normalization). In this study, we aimed to validate it in a larger cohort with serum PSA 2.5-10 ng/mL and test other selected transcripts and clinical parameters, including the percentage of free prostate-specific antigen (PSA) (% free PSA) and inflammation. In the main cohort of 299 men, we tested the quadruplex transcripts. In a subset of 146 men, we analyzed additional transcripts (CD45, EPCAM, EZH2, Ki67, PA2G4, PSGR, RHOA and TBP). After a prostate massage, the urine was collected, RNA isolated from a cell sediment and qRT-PCR performed. Ct values of KLK3 (i.e., PSA) were strongly correlated with Ct values of other genes which play a role in CaP (i.e., PCA3, AMACR, TRPM8, MSMB and PSGR). AMACR, PCA3, TRPM8 and EZH2 mRNA expression, as well as % free PSA, were significantly different for BPH and CaP. The best combined model (% free PSA plus PCA3 and AMACR) achieved an AUC of 0.728 in the main cohort. In the subset of patients, the best AUC 0.753 was achieved for the combination of PCA3, % free PSA, EPCAM and PSGR. PCA3 mRNA was increased in patients with inflammation, however, this did not affect the stratification of patients indicated for prostate biopsy. In conclusion, the percentage of free PSA and urinary markers contribute to a more accurate indication for prostate biopsy.
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Affiliation(s)
- Zlata Huskova
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, 779 00 Olomouc, Czech Republic; (Z.H.); (J.K.); (Z.K.)
| | - Jana Knillova
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, 779 00 Olomouc, Czech Republic; (Z.H.); (J.K.); (Z.K.)
| | - Zdenek Kolar
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, 779 00 Olomouc, Czech Republic; (Z.H.); (J.K.); (Z.K.)
| | - Jana Vrbkova
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic;
| | - Milan Kral
- Department of Urology, University Hospital, 779 00 Olomouc, Czech Republic
- Correspondence: (M.K.); (J.B.)
| | - Jan Bouchal
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, 779 00 Olomouc, Czech Republic; (Z.H.); (J.K.); (Z.K.)
- Correspondence: (M.K.); (J.B.)
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Hennenlotter J, Neumann T, Perner S, Wagner V, Stenzl A, Todenhöfer T, Rausch S. Impact of Histopathological Prostate Inflammation on Urine-Based Prostate Cancer Prediction Using the Prostate Cancer Gene 3 Score. Urol Int 2020; 104:483-488. [PMID: 32388502 DOI: 10.1159/000506885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Prostate Cancer gene 3 (PCA3) urine test has gained importance in the diagnostic workup of prostate cancer (PC). Limited evidence suggests that PCA3 is not altered in the presence of inflammation. OBJECTIVE To assess the impact of histological inflammation on PCA3. METHODS PCA3 was evaluated in patients prior to prostate biopsy (n = 193) and to radical prostatectomy (n = 197). In patients without PC, inflammation was assessed and quantified by individual scores integrating grade and extent. Uni- and multivariate analyses were performed to assess the impact of inflammation grade on PCA3. RESULTS The PCA3 scores prior to prostatectomy were lower (median 45) than those before positive biopsy (57; p = 0.008). Of 101 negative biopsies, 78% showed inflammation. The median PCA3 scores in the groups with no inflammation and with maximum grade 1 (n = 22), 2 (n = 38), and 3 (n = 19) inflammation were 45, 38, 27, and 25 (p = 0.016). The multivariate models revealed a decrease in PCA3 proportional to the grade and extent of inflammation (p < 0.04 each). CONCLUSIONS The present data imply that the PCA3 score decreases in the presence of inflammation, which is relevant, for instance, to testing after a recently performed biopsy. In general, inflammation should be regarded as a factor putatively influencing PCA3 and other available and upcoming PC tests.
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Affiliation(s)
- Jörg Hennenlotter
- Department of Urology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Tim Neumann
- Department of Urology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Sven Perner
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.,Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - Viktoria Wagner
- Department of Urology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Tilman Todenhöfer
- Department of Urology, Eberhard Karls University of Tübingen, Tübingen, Germany,
| | - Steffen Rausch
- Department of Urology, Eberhard Karls University of Tübingen, Tübingen, Germany
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Lemos AEG, Matos ADR, Ferreira LB, Gimba ERP. The long non-coding RNA PCA3: an update of its functions and clinical applications as a biomarker in prostate cancer. Oncotarget 2019; 10:6589-6603. [PMID: 31762940 PMCID: PMC6859920 DOI: 10.18632/oncotarget.27284] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer antigen 3 (PCA3) is an overexpressed prostate long non-coding RNA (lncRNA), transcribed from an intronic region at the long arm of human chromosome 9q21–22. It has been described that PCA3 modulates prostate cancer (PCa) cell survival through modulating androgen receptor (AR) signaling, besides controlling the expression of several androgen responsive and cancer-related genes, including epithelial–mesenchymal transition (EMT) markers and those regulating gene expression and cell signaling. Also, PCA3 urine levels have been successfully used as a PCa diagnostic biomarker. In this review, we have highlighted recent findings regarding PCA3, addressing its gene structure, putative applications as a biomarker, a proposed origin of this lncRNA, roles in PCa biology and expression patterns. We also updated data regarding PCA3 interactions with cancer-related miRNAs and expression in other tissues and diseases beyond the prostate. Altogether, literature data indicate aberrant expression and dysregulated activity of PCA3, suggesting PCA3 as a promising relevant target that should be even further evaluated on its applicability for PCa detection and management.
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Affiliation(s)
- Ana Emília Goulart Lemos
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública/Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.,Programa de Pós-Graduação em Ciências Biomédicas - Fisiologia e Farmacologia, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Aline da Rocha Matos
- Laboratório de Vírus Respiratórios e do Sarampo, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | | | - Etel Rodrigues Pereira Gimba
- Programa de Pós-Graduação em Ciências Biomédicas - Fisiologia e Farmacologia, Universidade Federal Fluminense, Rio de Janeiro, Brazil.,Coordenação de Pesquisa, Instituto Nacional do Câncer, Rio de Janeiro, Brazil.,Departamento de Ciências da Natureza (RCN), Instituto de Humanidades e Saúde, Universidade Federal Fluminense, Rio de Janeiro, Brazil
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Rodon N, Trias I, Verdú M, Calvo M, Banus JM, Puig X. Correlation of mRNA-PCA3 urine levels with the new grading system in prostate cancer. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2018; 52:20-26. [PMID: 30583827 DOI: 10.1016/j.patol.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/18/2018] [Accepted: 04/22/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the PCA3 (Prostate Cancer 3 gene) as a tool to improve prostate cancer (PCa) screening and its capability to predict PCa aggressiveness. PATIENTS AND METHODS A retrospective study with data from consecutive patients with suspected PCa seen in the urology department between November 2009 and April 2016 and who were candidates for prostate biopsy. A total of 1038 urine samples were tested in our laboratory with a kit that generated a PCA3 score (s-PCA3). A prostate biopsy was recommended only in those patients with s-PCA3≥35. Associations between variables were analyzed using the R software. RESULTS In patients with a positive s-PCA3 (44.5%), a subsequent biopsy was recommended. Of a total of 151 biopsies studied, 56.3% yielded a diagnosis of PCa. The probability of a positive biopsy increased as the s-PCA3 increased (p=0.041). The percentage of affected cylinders increased as the s-PCA3 increased (p=0.015). A statistically significant relationship was observed between s-PCA3 and both the Gleason score and the Grade Group (p=0.001 and 0.008, respectively). The best log-linear models and a logistic model confirmed the relationships shown previously with Fisher's exact tests. CONCLUSIONS S-PCA3 may serve as an additional marker to reduce the indication for biopsies and avoid overdiagnosis and overtreatment of patients with suspected PCa. The prognostic significance of s-PCA3 was confirmed, as it was associated with tumor volume and Gleason score. Importantly, to our knowledge this is the first time that an association has been demonstrated between s-PCA3 and the new Grade Group.
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Affiliation(s)
- Natalia Rodon
- BIOPAT, Biopatologia Molecular SL, Grup Assistència, Barcelona, Spain.
| | - Isabel Trias
- BIOPAT, Biopatologia Molecular SL, Grup Assistència, Barcelona, Spain; HISTOPAT Laboratoris, Barcelona, Spain; Hospital de Barcelona, SCIAS, Grup Assistència, Barcelona, Spain
| | - Montse Verdú
- BIOPAT, Biopatologia Molecular SL, Grup Assistència, Barcelona, Spain; HISTOPAT Laboratoris, Barcelona, Spain
| | - Miquel Calvo
- Department of Statistics, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
| | - Josep Mª Banus
- ICUN, Institut Català d'Urologia i Nefrologia, Barcelona, Spain
| | - Xavier Puig
- BIOPAT, Biopatologia Molecular SL, Grup Assistència, Barcelona, Spain; HISTOPAT Laboratoris, Barcelona, Spain; Hospital de Barcelona, SCIAS, Grup Assistència, Barcelona, Spain
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Prostate health index and prostate cancer gene 3 score but not percent-free Prostate Specific Antigen have a predictive role in differentiating histological prostatitis from PCa and other nonneoplastic lesions (BPH and HG-PIN) at repeat biopsy. Urol Oncol 2015; 33:424.e17-23. [PMID: 26162485 DOI: 10.1016/j.urolonc.2015.05.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/27/2015] [Accepted: 05/31/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if prostate health index (PHI), prostate cancer antigen gene 3 (PCA3) score, and percentage of free prostate-specific antigen (%fPSA) may be used to differentiate asymptomatic acute and chronic prostatitis from prostate cancer (PCa), benign prostatic hyperplasia (BPH), and high-grade prostate intraepithelial neoplasia (HG-PIN) in patients with elevated PSA levels and negative findings on digital rectal examination at repeat biopsy (re-Bx). PATIENTS AND METHODS In this prospective study, 252 patients were enrolled, undergoing PHI, PCA3 score, and %fPSA assessments before re-Bx. We used 3 multivariate logistic regression models to test the PHI, PCA3 score, and %fPSA as risk factors for prostatitis vs. PCa, vs. BPH, and vs. HG-PIN. All the analyses were performed for the whole patient cohort and for the "gray zone" of PSA (4-10ng/ml) cohort (171 individuals). RESULTS Of the 252 patients, 43 (17.1%) had diagnosis of PCa. The median PHI was significantly different between men with a negative biopsy and those with a positive biopsy (34.9 vs. 48.1, P<0.001), as for the PCA3 score (24 vs. 54, P<0.001) and %fPSA (11.8% vs. 15.8%, P = 0.012). The net benefit of using PCA3 and PHI to differentiate prostatitis and PCa was moderate, although it extended to a good range of threshold probabilities (40%-100%), whereas that from using %fPSA was negligible: this pattern was reported for the whole population as for the "gray zone" PSA cohort. CONCLUSION In front of a good diagnostic performance of all the 3 biomarkers in distinguishing negative biopsy vs. positive biopsy, the clinical benefit of using the PCA3 score and PHI to estimate prostatitis vs. PCa was comparable. PHI was the only determinant for prostatitis vs. BPH, whereas no biomarkers could differentiate prostate inflammation from HG-PIN.
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De Luca S, Passera R, Cappia S, Bollito E, Randone DF, Milillo A, Papotti M, Porpiglia F. Fluctuation in prostate cancer gene 3 (PCA3) score in men undergoing first or repeat prostate biopsies. BJU Int 2014; 114:E56-E61. [DOI: 10.1111/bju.12654] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Stefano De Luca
- Department of Urology; San Luigi Gonzaga Hospital; Orbassano Italy
| | - Roberto Passera
- Department of Nuclear Medicine; San Giovanni Battista Hospital; Torino Italy
- University of Torino; Torino Italy
| | - Susanna Cappia
- Department of Pathology; San Luigi Gonzaga Hospital; Orbassano Italy
| | - Enrico Bollito
- Department of Pathology; San Luigi Gonzaga Hospital; Orbassano Italy
| | | | - Angela Milillo
- Department of Laboratory Medicine; Gradenigo Hospital; Torino Italy
| | - Mauro Papotti
- Department of Pathology; San Luigi Gonzaga Hospital; Orbassano Italy
- University of Torino; Torino Italy
| | - Francesco Porpiglia
- Department of Urology; San Luigi Gonzaga Hospital; Orbassano Italy
- University of Torino; Torino Italy
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Rodón N, Trías I, Verdú M, Román R, Domínguez A, Calvo M, Banus J, Ballesta A, Maestro M, Puig X. Diagnostic and predictive value of urine PCA3 gene expression for the clinical management of patients with altered prostatic specific antigen. Actas Urol Esp 2014; 38:150-5. [PMID: 24099827 DOI: 10.1016/j.acuro.2013.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 06/05/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Analyze the impact of the introduction of the study of PCA3 gene in post-prostatic massage urine in the clinical management of patients with PSA altered, evaluating its diagnostic ability and predictive value of tumor aggressiveness. METHODS Observational, prospective, multicenter study of patients with suspected prostate cancer (PC) candidates for biopsy. We present a series of 670 consecutive samples of urine collected post-prostatic massage for three years in which we determined the "PCA3 score" (s-PCA3). Biopsy was only indicated in cases with s-positive PCA3. RESULTS The s-PCA3 was positive in 43.7% of samples. In the 124 biopsies performed, the incidence of PC or atypical small acinar proliferation was 54%, reaching 68,6% in s-PCA3≥100. Statistically significant relationship between the s-PCA3 and tumor grade was demonstrated. In cases with s-PCA3 between 35 and 50 only 23% of PC were high grade (Gleason≥7), compared to 76.7% in cases with s-PCA3 over 50. There was a statistically significant correlation between s-PCA3 and cylinders affected. Both relationships were confirmed by applying a log-linear model. CONCLUSIONS The incorporation of PCA3 can avoid the need for biopsies in 54% of patients. s-PCA3 positivity increases the likelihood of a positive biopsy, especially in higher s-PCA3 100 (68.6%). s-PCA3 is also an indicator of tumor aggressiveness and provides essential information in making treatment decisions.
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Schröder FH, Venderbos LD, van den Bergh RC, Hessels D, van Leenders GJ, van Leeuwen PJ, Wolters T, Barentsz JO, Roobol MJ. Prostate Cancer Antigen 3: Diagnostic Outcomes in Men Presenting With Urinary Prostate Cancer Antigen 3 Scores ≥100. Urology 2014; 83:613-6. [DOI: 10.1016/j.urology.2013.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 11/19/2013] [Accepted: 12/03/2013] [Indexed: 11/24/2022]
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