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- Decisions…decisions….
Sounds very straight forward to me. How about you? Not to pick on the American Cancer Society, but what if the discussion about whether to consider the PSA was the status quo in the diagnosis of breast cancer and mamograms? “Mrs. Smith. Before you consider a mamogram, it may be positive and that may require a biopsy and that biopsy may or may not be positive. If negative you may still have an undiagnosed breast cancer. If positive you may elect a treatment that is not necessary or cause disfiguring side effects. So, Mrs. Smith, what are you thoughts on being checked for breast cancer? Mrs. Smith, Mrs. Smith…?”
Mrs. Smith: ” I am sorry you lost me with the first part. I just want to know if I have breast cancer or not.”
Should prostate cancer be treated any different from breast cancer?
Purpose
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.
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.
Methods
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.
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.
Results
The PCA3 Assay was mainly considered appropriate in men with
≥1 negative biopsy, PSA ≥ 3 ng/mL and life expectancy (LE) ≥10 years. A
LE < 10 years, ≥2 negative biopsies and PCA3 Score <20 decreased biopsy
appropriateness, while PSA ≥ 3 ng/mL and PCA3 Score >50 increased it. In men
without a prior biopsy, LE ≥ 10 years and a suspicious DRE, PCA3 did not affect
biopsy appropriateness. In other men, a PCA3 Score <20 discouraged biopsy,
while a value ≥35 supported biopsy. AS was mainly considered appropriate if
LE < 10 years, T1c PCa, ≤20% positive cores and PSA < 3 ng/mL. A PCA3
Score <20 pleads for and higher scores (particularly >50) against AS.
≥1 negative biopsy, PSA ≥ 3 ng/mL and life expectancy (LE) ≥10 years. A
LE < 10 years, ≥2 negative biopsies and PCA3 Score <20 decreased biopsy
appropriateness, while PSA ≥ 3 ng/mL and PCA3 Score >50 increased it. In men
without a prior biopsy, LE ≥ 10 years and a suspicious DRE, PCA3 did not affect
biopsy appropriateness. In other men, a PCA3 Score <20 discouraged biopsy,
while a value ≥35 supported biopsy. AS was mainly considered appropriate if
LE < 10 years, T1c PCa, ≤20% positive cores and PSA < 3 ng/mL. A PCA3
Score <20 pleads for and higher scores (particularly >50) against AS.
