Method: Participants were invited for rescreening between October 2007 and February 2009 within the Dutch part of the ERSPC study. Biopsies were taken in men with PSA level ≥3.0ng/ml or PCA3 score ≥ 10. Additional analyses of the k-panel were done on serum samples. Receiver operating characteristics (ROC) curve and decision curve analysis (DCA) were performed to compare the predictive capabilities of PCA3, k-panel, the ERSPC risk calculator, and their combinations in logistic regression models.
Result: PCa was detected in 119 out of 708 men (17%). PCA3 discriminated better than the k-panel when modeled univariately (AUC 0.63 vs. 0.53; p <0.01). An ERSPC risk calculator with PCA3 performed significantly better than the ERSPC risk calculator alone (AUC 0.73 vs. 0.70 p=0.02), while adding the k-panel only showed a trend to increase the accuracy in the subset of men with PSA ≥3.0ng/ml (AUC 0.79 vs 0.81; p=0.24). Decision curves confirmed these patterns.
Conclusion: PCA3 has a small added value to the ERSPC risk calculator in detecting PCa in prescreened man. Further research is needed to determine whether adding PCA3 or a k-panel to the ERSPC risk calculator is of benefit in certain subgroups of men at risk for PCa.