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Study Type – Diagnosis (exploratory cohort) Level of Evidence 2b OBJECTIVE To determine the performance characteristics of the prostate cancer gene 3 (PCA3) score on the outcome of biopsy relative to different ranges of free-to-total prostate-specific antigen (PSA) ratio (f/tPSA) in men with a previous negative biopsy and a PSA level of 2.5–10 ng/mL, as urine tests like PCA3 are currently under investigation in order to improve prostate cancer diagnosis and to decrease the rate of unnecessary rebiopsies. PATIENTS AND METHODS Data from the previous prospective European multicentre study were reviewed. Only patients with a PSA level of 2.5–10 ng/mL were included in the present study. In all, 301 patients had complete data. The diagnostic accuracy of the PCA3 score for predicting a positive biopsy outcome was studied using sensitivity, specificity, negative and positive predictive values. The PCA3 performance was evaluated relative to three different subgroups of f/tPSA, as follows: >20% (group 1), 10–20% (group 2) and 30, vs 10.3%, 15.5% and 28.6% when the PCA3 score was 30 was a significant independent predictor of positive biopsies (odds ratio 3.01; 95% confidence interval 1.74–5.23; P < 0.001). CONCLUSIONS PCA3 remained a better predictor of prostate cancer than f/tPSA. In men with a f/tPSA of >10%, the use of the PCA3 score was highly correlated with the risk of having cancer on re-biopsy, and could prevent unnecessary prostate biopsies if the value is low.

to determine the performance characteristics of the prostate cancer gene 3 (PCA3) score on the outcome of biopsy relative to different ranges of free-to-total prostate-specific antigen (PSA) ratio (f/tPSA) in men with a previous negative biopsy and a PSA level of 2.5-10 ng/mL, as urine tests like PCA3 are currently under investigation in order to improve prostate cancer diagnosis and to decrease the rate of unnecessary rebiopsies.data from the previous prospective European multicentre study were reviewed. Only patients with a PSA level of 2.5-10 ng/mL were included in the present study. In all, 301 patients had complete data. The diagnostic accuracy of the PCA3 score for predicting a positive biopsy outcome was studied using sensitivity, specificity, negative and positive predictive values. The PCA3 performance was evaluated relative to three different subgroups of f/tPSA, as follows:20% (group 1), 10-20% (group 2) and10% (group 3).the prostate cancer detection rates were 18.8%, 23.9% and 34.8% in groups 1, 2 and 3, respectively. The area under the receiver operating characteristic curve of the PCA3 score, total PSA and f/tPSA was 0.688, 0.553 and 0.571, respectively. The percentage of men with positive biopsies was 30.6%, 37.0% and 44.4% in those with a PCA3 score of30, vs 10.3%, 15.5% and 28.6% when the PCA3 score was30, in groups 1, 2 and 3, respectively. The difference was significant only in groups 1 and 2. In men with a f/tPSA of ≤ 10% the difference in detection rates relative to the PCA3 score was not statistically significant regardless of which PCA3 threshold was used. A high PCA3 score was significantly associated with age, clinical T2 stage and positive biopsy (P0.001, 0.013 and0.001, respectively). In bivariate analysis accounting for the PCA3 score and the f/tPSA, a PCA3 score of30 was a significant independent predictor of positive biopsies (odds ratio 3.01; 95% confidence interval 1.74-5.23; P0.001).PCA3 remained a better predictor of prostate cancer than f/tPSA. In men with a f/tPSA of10%, the use of the PCA3 score was highly correlated with the risk of having cancer on re-biopsy, and could prevent unnecessary prostate biopsies if the value is low.

Introduction: The study assessed the treatment of intrinsic sphincter deficiency with the ACT™ system in neurogenic patients. Material and methods: The ACT™ consists of two postoperatively adjustable silicone balloons placed paraurethrally in females and at the prostatic apex, or vesico-urethral anastomosis in males. Balloon titration is via tubing connected to a titanium port in the labia majora or scrotum. Efficacy assessment was based on technical feasibility and patient assessment of leakage and acceptance. Results: Eighteen implantations including three revisions were performed on 12 females and three males. Mean age was 51.9 years, mean follow-up was 18 (8–40) months with a mean neurogenic history of 15 years (1 to 54). Aetiology of neurogenic disease was mixed and included degenerative; spinal cord injury; oncological, vascular and congenital disorders with most patients self catheterising and using either anticholinergics and/ or Botox or had previously undergone enterocystoplasty. Procedure was performed using local (72%), general (5.5%) or no anaesthesia (22%). At follow up, seven patients were dry and pad free(46%), six improved (not requesting any further adjustment)(40%), two failed. 8/30 devices were explanted in five patients due to erosion (six), device failure (one) and treatment failure (one). 3/5 have been reimplanted, with 1/5 planned for reimplantation. Of these three patients, two were dry and one significantly improved. No major complication has been described. Conclusion: ACT balloons may be considered for treatment of ISD in neurogenic patients provided that patients are informed of the increased risk of erosion, and the possibility of secondary implantation.