PCA3 score

Click for an information sheet on PCA3

What is the PCA3 score?

This is a new genetic test that determines whether products of genes associated with prostate cancer are present in the urine of men.

How do I get the test done?

A sample of urine that contains prostate cells is needed. This is obtained from the first part of the urine passed after the prostate has been examined with a finger. The sample is cooled and sent for analysis. No blood is taken.

What does the PCA3 score tell you? 

A numerical score is obtained and the value of this gives an idea on how likely prostate biopsies are to show prostate cancer. The data are new, but a rough idea using the PCA3 score alone is shown below:


PCA3 Score

Probability of prostate cancer on  biopsy

<5

14%

5-19

26%

20-34

37%

35-49

47%

50-100

55%

>100

78%



As you can see, it does not rule in or rule out prostate cancer, and the chance of prostate cancer is variable. 

However, the PCA3 score is significantly better than PSA alone, and when used in conjunction with the PSA value, digital rectal examination findings, age, prostate size and percentage free PSA, it is possible to make a better estimate about the risk of biopsy-detectable prostate cancer. The data have been used to generate a research model to give an overall probability. This has been presented at the European Association of Urology annual meeting 2008.This seems to be the best, but has not yet been published. We have this but we are unable to quote it until it is actually  published.

A prostate biopsy is still necessary to prove if cancer is present or not.

Does the PCA3 score tell you how serious the cancer is, and whether treatment might be necessary?

This year, two scientific studies have been published that show the PCA3 score does and does not correspond with the severity of prostate cancer. As such, it is not possible to know yet with any reliability whether the PCA3 score is likely to be able to tell who should and who should not have treatment for prostate cancer.

How does the PCA3 score compare with PSA?

The results are more accurate than PSA alone, but are not sufficient to rely on in isolation. The PCA3 score is not affected by the size of the prostate, unlike PSA. It is also less affected by urinary infections, which can make PSA completely unreliable.  It is not yet entirely clear if drugs can affect PSA. It is possible that reduced levels of testosterone or dihydrotestosterone that can occur with age or on drugs (e.g. LHRH agonists, bicalutamide or finasteride) might influence the results.
 

References


1: Whitman EJ, Groskopf J, Ali A, Chen Y, Blase A, Furusato B, Petrovics G, Ibrahim M, Elsamanoudi S, Cullen J, Sesterhenn IA, Brassell S, Rittenhouse H, Srivastava S, McLeod DG. PCA3 Score Before Radical Prostatectomy Predicts Extracapsular Extension and Tumor Volume.J Urol. 2008 Sep 16.

2: van Gils MP, Hessels D, Hulsbergen-van de Kaa CA, Witjes JA, Jansen CF, Mulders PF, Rittenhouse HG, Schalken JA. Detailed analysis of histopathological parameters in radical prostatectomy
specimens and PCA3 urine test results. Prostate. 2008 Aug 1;68(11):1215-22.

3: Loeb S. Does PCA3 Help Identify Clinically Significant Prostate Cancer? Eur Urol. 2008 Jul 16. 
 
4: Marks LS, Bostwick DG.Prostate Cancer Specificity of PCA3 Gene Testing: Examples from Clinical
Practice. Rev Urol. 2008 Summer;10(3):175-81.

5: Haese A, de la Taille A, van Poppel H, Marberger M, Stenzl A, Mulders PF,Huland H, Abbou CC, Remzi M, Tinzl M, Feyerabend S, Stillebroer AB, van Gils MP,
Schalken JA. Clinical Utility of the PCA3 Urine Assay in European Men Scheduled for Repeat Biopsy. Eur Urol. 2008 Jun 26. 

6: Nakanishi H, Groskopf J, Fritsche HA, Bhadkamkar V, Blase A, Kumar SV, DavisJW, Troncoso P, Rittenhouse H, Babaian RJ. PCA3 molecular urine assay correlates with prostate cancer tumor volume:implication in selecting candidates for active surveillance. J Urol. 2008 May;179(5):1804-9; discussion 1809-10. Epub 2008 Mar 18.

7: Deras IL, Aubin SM, Blase A, Day JR, Koo S, Partin AW, Ellis WJ, Marks LS, Fradet Y, Rittenhouse H, Groskopf J. PCA3: a molecular urine assay for predicting prostate biopsy outcome. J Urol. 2008 Apr;179(4):1587-92. Epub 2008 Mar 4.

8: Sokoll LJ, Ellis W, Lange P, Noteboom J, Elliott DJ, Deras IL, Blase A, Koo S, Sarno M, Rittenhouse H, Groskopf J, Vessella RL. A multicenter evaluation of the PCA3 molecular urine test: pre-analytical
effects, analytical performance, and diagnostic accuracy. Clin Chim Acta. 2008 Mar;389(1-2):1-6. Epub 2007 Nov 17.

9: Marks LS, Fradet Y, Deras IL, Blase A, Mathis J, Aubin SM, Cancio AT, Desaulniers M, Ellis WJ, Rittenhouse H, Groskopf J. PCA3 molecular urine assay for prostate cancer in men undergoing repeat biopsy. Urology. 2007 Mar;69(3):532-5.

10: Schalken J. Molecular diagnostics and therapy of prostate cancer: new avenues. Eur Urol. 1998;34 Suppl 3:3-6. Review.