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Patients with dual negative tests may not require repeat prostate biopsy

25 May 2018

Patients with dual negative tests (multiparametric magnetic resonance imaging [MRI] and prostate cancer antigen 3 [PCA3] score) do not present with clinically significant prostate cancer on biopsy, suggesting that biopsy may not be needed in this group, a recent study has shown.

Of the patients, 32.5 percent had abnormal PCA3 score at 35 or greater. The multivariable model, including 154 men, showed that only age (odds ratio [OR], 1.08; 95 percent CI, 1.01–1.16), multiparametric MRI PI-RADS (Prostate Imaging-Reporting and Data System) score 4 (OR, 16.6; 3.9–70.0) or 5 (OR, 28.3; 5.7–138) and PCA3 score (OR, 2.9; 1.0–8.8) were predictors of clinically significant cancer on biopsy.

In patients with negative multiparametric MRI and a normal PCA3 score, no clinically significant prostate cancer was found on biopsy, resulting in a negative predictive value of 100 percent (p<0.0001).

In this study, clinicopathological data on all patients in whom a PCA3 test was done were collected from January 2011 to June 2016 in accordance with ethics committee approval. Participants (n=470) included patients on active surveillance for low-risk prostate cancer and those without prostate cancer who had previous negative biopsies and suspicion of occult disease.

Researchers explored whether age, prostate-specific antigen, PCA3 score, multiparametric MRI, digital rectal examination, family history and prostate size were predictors of clinically significant prostate cancer on repeat biopsy. They also calculated the negative predictive value of multiparametric MRI and PCA3 score.

“This study was limited by its retrospective design, selection bias and lack of cost-effectiveness data,” researchers said.

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