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Re: Felix K. Chun, Alexandre de la Taille, Hendrik van Poppel, et al. Prostate Cancer Gene 3 (PCA3): Development and Internal Validation of a Novel Biopsy Nomogram. Eur Urol 2009;56:659–68
EUROPEAN UROLOGY 57 (2010) e1
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Letter to the Editor Re: Felix K. Chun, Alexandre de la Taille, Hendrik van Poppel, et al. Prostate Cancer Gene 3 (PCA3): Development and Internal Validation of a Novel Biopsy Nomogram. Eur Urol 2009;56:659–68 An ideal marker for the early detection of prostate cancer (PCa) should differentiate patients having an isolated highgrade prostatic intraepithelial neoplasia (HGPIN) from those with PCa [1]. Chun et al have made a great effort to validate the prostate cancer gene 3 (PCA3) score as a marker of PCa in urine after prostate massage [2]. The most important news, however, is the biopsy nomogram for the prediction of PCa based on the PCA3 score in which other variables such as age, serum prostate-specific antigen, digital rectal examination, prostate volume, and biopsy history have been included. This type of tool is very helpful to make individual decisions, especially for those men who have undergone just one biopsy or multiple repeated biopsies. The detection of HGPIN in a prostate biopsy is actually controversial in terms of deciding if repeat biopsy should be done and when would be the appropriate time to do the procedure. A recent study suggested that multifocal HGPIN is highly associated with PCa, whereas unifocal HGPIN does not differ from the normal population [3]. We recently observed that overexpression of PTOV1 in HGPIN lesions is a potent predictor of associated PCa; however, our encouraging results need to be validated before we can make any recommendations [1]. The preceding comments lead me to suggest that a previous history of HGPIN should be included as a variable in a multivariate analysis, and if significant, it should be incorporated in a biopsy nomogram based on PCA3 score for men with previous biopsy. This proposal is supported by three facts. First, PCA3 is also overexpressed in HGPIN [4]. Second, in the European
series of 463 men subjected to repeat biopsy, Haese et al. [5] observed that PCA3 score was higher in men with HGPIN than in those without. Third, according to our own results, the PCA3 score is less effective at predicting PCa in men with previous HGPIN (data not published). I encourage Chun and colleagues to consider incorporating the history of previous HGPIN as a predictive variable in a multivariate analysis and to generate a new nomogram based on PCA3 for men with previous negative biopsy. Conflicts of interest: The author has nothing to disclose.
References ˜a L, et al. PTOV1 expression predicts [1] Morote J, Ferna´ndez S, Alan prostate cancer in men with isolated high-grade prostatic intraepithelial neoplasia in needle biopsy. Clin Cancer Res 2008;14: 2617–22. [2] Chun FK, de la Taille A, van Poppel H, et al. Prostate cancer gene 3 (PCA3): development and internal validation of a novel biopsy nomogram. Eur Urol 2009;56:659–68. [3] Merrimen J, Jones G, Walker D, Leung C, Kapusta L, Srigley J. Multifocal high grade prostatic intraepithelial neoplasia is a significant risk factor for prostatic adenocarcinoma. J Urol 2009;182: 485–90. [4] Popa I, Fradet Y, Beaudry G, Hovington H, Tetu B. Identification of PCA3 (DD3) in prostatic carcinoma by in situ hybridization. Mod Pathol 2007;20:1121–7. [5] Haese A, de la Taille A, van Poppel H, et al. Clinical utility of the PCA3 urine assay in European men scheduled for repeat biopsy. Eur Urol 2008;54:1081–8. Juan Morote Department of Urology, Auto´noma University of Barcelona, Spain E-mail address: [email protected] September 30, 2009 Published online on October 9, 2009
DOI of original article: 10.1016/j.eururo.2009.03.029 0302-2838/$ – see back matter # 2009 Published by Elsevier B.V. on behalf of European Association of Urology. doi:10.1016/j.eururo.2009.09.041
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Letter to the Editor Re: Felix K. Chun, Alexandre de la Taille, Hendrik van Poppel, et al. Prostate Cancer Gene 3 (PCA3): Development and Internal Validation of a Novel Biopsy Nomogram. Eur Urol 2009;56:659–68 An ideal marker for the early detection of prostate cancer (PCa) should differentiate patients having an isolated highgrade prostatic intraepithelial neoplasia (HGPIN) from those with PCa [1]. Chun et al have made a great effort to validate the prostate cancer gene 3 (PCA3) score as a marker of PCa in urine after prostate massage [2]. The most important news, however, is the biopsy nomogram for the prediction of PCa based on the PCA3 score in which other variables such as age, serum prostate-specific antigen, digital rectal examination, prostate volume, and biopsy history have been included. This type of tool is very helpful to make individual decisions, especially for those men who have undergone just one biopsy or multiple repeated biopsies. The detection of HGPIN in a prostate biopsy is actually controversial in terms of deciding if repeat biopsy should be done and when would be the appropriate time to do the procedure. A recent study suggested that multifocal HGPIN is highly associated with PCa, whereas unifocal HGPIN does not differ from the normal population [3]. We recently observed that overexpression of PTOV1 in HGPIN lesions is a potent predictor of associated PCa; however, our encouraging results need to be validated before we can make any recommendations [1]. The preceding comments lead me to suggest that a previous history of HGPIN should be included as a variable in a multivariate analysis, and if significant, it should be incorporated in a biopsy nomogram based on PCA3 score for men with previous biopsy. This proposal is supported by three facts. First, PCA3 is also overexpressed in HGPIN [4]. Second, in the European
series of 463 men subjected to repeat biopsy, Haese et al. [5] observed that PCA3 score was higher in men with HGPIN than in those without. Third, according to our own results, the PCA3 score is less effective at predicting PCa in men with previous HGPIN (data not published). I encourage Chun and colleagues to consider incorporating the history of previous HGPIN as a predictive variable in a multivariate analysis and to generate a new nomogram based on PCA3 for men with previous negative biopsy. Conflicts of interest: The author has nothing to disclose.
References ˜a L, et al. PTOV1 expression predicts [1] Morote J, Ferna´ndez S, Alan prostate cancer in men with isolated high-grade prostatic intraepithelial neoplasia in needle biopsy. Clin Cancer Res 2008;14: 2617–22. [2] Chun FK, de la Taille A, van Poppel H, et al. Prostate cancer gene 3 (PCA3): development and internal validation of a novel biopsy nomogram. Eur Urol 2009;56:659–68. [3] Merrimen J, Jones G, Walker D, Leung C, Kapusta L, Srigley J. Multifocal high grade prostatic intraepithelial neoplasia is a significant risk factor for prostatic adenocarcinoma. J Urol 2009;182: 485–90. [4] Popa I, Fradet Y, Beaudry G, Hovington H, Tetu B. Identification of PCA3 (DD3) in prostatic carcinoma by in situ hybridization. Mod Pathol 2007;20:1121–7. [5] Haese A, de la Taille A, van Poppel H, et al. Clinical utility of the PCA3 urine assay in European men scheduled for repeat biopsy. Eur Urol 2008;54:1081–8. Juan Morote Department of Urology, Auto´noma University of Barcelona, Spain E-mail address: [email protected] September 30, 2009 Published online on October 9, 2009
DOI of original article: 10.1016/j.eururo.2009.03.029 0302-2838/$ – see back matter # 2009 Published by Elsevier B.V. on behalf of European Association of Urology. doi:10.1016/j.eururo.2009.09.041