PCA3 - Prostate Cancer Biomarker

PCA3 - Prostate Cancer Biomarker by Transcription-Mediated Amplification 2010102
Method: Qualitative Transcription-Mediated Amplification

Aid in decision to repeat biopsy in men ≥50 years who have had one or more negative prostate biopsies and for whom a repeat biopsy would be recommended by a urologist based on current standard of care

Collect specimen after DRE

Not for use as initial prostate cancer screening

Sufficient number of prostate cells must be present in urine for analysis

PCA3 testing should not be used for men with atypical small acinar proliferation (ASAP) on their most recent biopsy

Related Tests
Prostate Specific Antigen, Total 0070121
Method: Quantitative Electrochemiluminescent Immunoassay

Preferred initial screening test for prostate cancer in conjunction with DRE

Monitor patients for recurrence of cancer

Prostate Specific Antigen, Free Percentage (Includes Free PSA and Total PSA) 0080206
Method: Quantitative Electrochemiluminescent Immunoassay

Percentage of free PSA compared to total PSA

May provide additional prostate cancer risk information for patients with mildly elevated total PSA and a negative DRE

Alternative to PCA3 testing in indeterminate PSA cases

Not for initial prostate cancer screen

Prostate cancer is the most frequent malignant neoplasm in men and the second most common cause of cancer-related deaths in American men.  PCA3 testing may be useful in conjunction with other patient information to determine whether a biopsy should be repeated in men ≥50 years.

Disease Overview

Physiology

PCA3 is noncoding RNA and is overexpressed in >95% of prostate cancer tissue. PCA3 has a median 66-fold upregulation compared with adjacent nonneoplastic tissue.

Diagnostic Issues

PCA3 testing can be helpful in determining whether to perform a first or repeat biopsy in patients with indeterminate PSA results.

Test Interpretation

Clinical sensitivity: 77.5% relative to prostate biopsy outcome; based on a PCA3 ratio cutoff value of 25

Clinical specificity: 57.1% relative to prostate biopsy outcome; based on a PCA3 ratio cutoff value of 25

Results

Result PCA3 Ratio Interpretation

Negative

0-17

Associated with decreased likelihood of a positive biopsy for prostate cancer

18-24

Should be interpreted with caution; due to normal test variability, specimens with PCA3 scores near the cutoff may yield a different overall interpretation upon repeat testing

Positive

25-31

Should be interpreted with caution; due to normal test variability, specimens with PCA3 scores near the cutoff may yield a different overall interpretation upon repeat testing

>31

Associated with increased probability of a positive biopsy for prostate cancer

References 
  1. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer Early Detection, Version 2.2018. National Comprehensive Cancer Network. Fort Washington, PA [Updated: Apr 2018; Accessed: Jun 2018]

Last Update: November 2019