PSA, PCA3, and prostate cancer diagnosis today

A new review just published in BJU International provides a current expert perspective on the roles of PSA and the much newer PCA3 test in the work-up and diagnosis of a patient suspected of prostate cancer. The entire article is available on line and will be a useful resource for many support group leaders and other prostate cancer educators.

Kirby et al. have conducted a thorough review of the current data on the work-up of the patient suspected to be at risk for prostate cancer. They examine the current diagnostic dilemmas, the weaknesses of traditional testing, and place particular emphasis on the potential of the PCA3 test to add to the information historically provided by PSA testing.

Their conclusion reads as follows:

Over the past two decades, serum tPSA, together with other indicators, has guided biopsy decisions for urologists. While research during this period has characterized the strengths of tPSA testing, many weaknesses have also been revealed. The discovery and clinical evaluation of PCA3 has shown that the marker supplements tPSA in diagnosis and is insensitive to the nonspecific factors that can affect circulating tPSA levels. The addition of PCA3 to the urologist’s diagnostic tools will not result in a state of certainty; however, diagnostic sensitivity, specificity and predictive value are incrementally improved by its inclusion. In turn, biopsy and management decisions might be better informed. This has the potential to improve the overall level of patient care.

2 Responses

  1. Now how long will it take for PCA3 testing to replace PSA testing both as a prequel to biopsy and as a way to define biochemical failure following treatment?

  2. Steve: I don’t think that the PCA3 test will or should “replace” PSA testing. I think the better question is how long it will take for it to be used consistently in conjunction with PSA testing. It could take maybe 2-3 years for this work its way through broadly to the community urology level.

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