PCA3 - Prostate Cancer Biomarker
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
Preferred initial screening test for prostate cancer in conjunction with DRE
Monitor patients for recurrence of cancer
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 |
- 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
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