TMRPSS2-ERG and PCA3 as markers of risk for men entering active surveillance protocols


A new study just published on line in Clinical Cancer Research shows a degree of correlation between the results of tests for PCA3 and the TMRPSS2-ERG biomarker and risk for progressive disease in men on active surveillance. However, this correlation appears to be less than compelling.

As a component of the Canary Foundation’s Prostate Active Surveillance Study (PASS), Lin et al. collected urine after a vigorous DRE from 387 men who were entering this active surveillance protocol at one of several associated institutions. The usrine was then analyzed for PCA3 and TMPRSS2-ERG levels and biomarker scores were correlated to clinical and pathologic variables.

Here is what the research team has found to date:

  • PCA3 and TMPRSS2-ERG scores were significantly associated with higher volume disease.
    • Median PCA3 and TMPRSS2-ERG scores increased incrementally (P < 0.005) among men with repeat biopsy results that were negative or showed positive cores with 1-10, 11-33, or ≥34 positive results.
  • PCA3 and TMPRSS2-ERG scores were significantly associated with presence of high-grade disease.
    • Median PCA3 and TMPRSS2-ERG scores increased incrementally compared to those of men with as negative biopsy among men with Gleason 6 disease (P = 0.02) and men with Gleason ≥7 disease (P = 0.001).
  • The odds ratios (ORs) for a biopsy in which cancer was detected versus a negative repeat biopsy ( the reference value) were:
    • For the PCA3 test, OR = 1.41; P = 0.01.
    • For the  TMPRSS2-ERG test, OR = 1.28; P = 0.001.

Lin and his collegaues conclude that,

For men on active surveillance both PCA3 and TMPRSS2-ERG appear to stratify risk of having aggressive cancer as defined by tumor volume or Gleason score.

This is certainly a reasonable conclusion. However, it does not immediately seem to be evident that either of these tests is necessarily a really good way to be able to tell whether a specific individual is at high probability for clinically significant as opposed to clinically insignificant disease.

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