Urinary testing for TMPRSS2: ERG and PCA3 improve detection of aggressive prostate cancer

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IMPORTANCE Potential survival benefits from treating aggressive (Gleason score ≥7) early-stage prostate cancer are undermined by harms from unnecessary prostate biopsy and overdiagnosis of indolent disease.

OBJECTIVE To evaluate the a priori primary hypothesis that combined measurement of PCA3 and TMPRSS2:ERG (T2:ERG) RNA in the urine after digital rectal examination would improve specificity over measurement of prostate-specific antigen alone for detecting cancer with Gleason score of 7 or higher. As a secondary objective, to evaluate the potential effect of such urine RNA testing on health care costs.

DESIGN, SETTING, AND PARTICIPANTS Prospective, multicenter diagnostic evaluation and validation in academic and community-based ambulatory urology clinics. Participants were a referred sample of men presenting for first-time prostate biopsy without preexisting prostate cancer: 516 eligible participants from among 748 prospective cohort participants in the developmental cohort and 561 eligible participants from 928 in the validation cohort.

INTERVENTIONS/EXPOSURES Urinary PCA3 and T2:ERG RNA measurement before prostate biopsy.

MAIN OUTCOMES AND MEASURES Presence of prostate cancer having Gleason score of 7 or higher on prostate biopsy. Pathology testing was blinded to urine assay results. In the developmental cohort, a multiplex decision algorithm was constructed using urine RNA assays to optimize specificity while maintaining 95%sensitivity for predicting aggressive prostate cancer at initial biopsy. Finding...