Many American men have heard that a recent task force advised against PSA testing for ALL men. I have weighed in on this advice in a previous blog and suggest that all men over the age of 50 and all men at increased risk for prostate cancer which include African-American men and men with a close relative with prostate cancer have a discussion with their doctor about PSA testing.
Now there is a new test, PCA3 which is more sensitive than the standard PSA test and can be helpful 1) for men who have an elevated PSA make a decision regarding a biopsy, 2) for men who have had a negative biopsy but there is a suspicion that prostate cancer is present, or 3) for men with a positive biopsy for prostate cancer and to know how aggressive is the prostate cancer which may help suggest if treatment is indicated or if watchful waiting is the appropriate form of management.
The PCA3 test a gene-based test to aid in the diagnosis of prostate cancer. The test consists of a urine sample collected after a digital rectal examination. The doctor will receive the results as a numerical value between 4-125. The higher the PCA3 score the more likely the biopsy will be positive. The lower the PCA3 score the more likely the biopsy will be positive. Keep in mind that the decision to perform a biopsy is also dependent on other factors such as your age, family history of prostate cancer, and the results of the digital rectal exam, prostate size and PSA value. If you and your doctor decide not to perform a biopsy, you may repeat the PCA3 test after 3-6 months. In the absence of prostate cancer, the PCA3 score will remain the same or vary only slightly over time. If the PCA3 increases significantly, a biopsy may be indicated.
Bottom Line: the digital rectal examination and the PSA test are still good screening tests for prostate cancer. The PCA3 test is a refinement of the other two tests and help make the diagnosis of prostate cancer and help decide upon the treatment or help with the monitoring of patients who decide to follow their cancer with watchful waiting.