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PCA3 - Based Prostate Cancer Smart Screening Analysis
Considering PCA3? High PCA3? | Before prostate cancer biopsy: analyze your PSA trend, use new screening technology and consider smart screening strategy analysis.
PSA is the prostate-specific antigen blood test measured in ng/mL that reflects prostate conditions.
Learn more about your elevated or high PSA test level:
To improve on PSA screening for prostate cancer, Hologic, Inc. provides the Progensa PCA3 genetic urine test.
Learn more about Prostate Smart Screening for Cancer at our home page in a new window
Take Next Steps to Develop Your Smart Screening Strategy
- Understand your "Underlying" "True" elevated or high PSA.
- Why does 4Kscore improve PSA screening effectiveness?
- Interpret your 4Kscore, elevated or high PSA and prostate volume.
- Analyze your elevated or high PSA trend and high 4Kscore trend.
- Compare 4Kscore to other enhanced tests - blood or urine.
- Develop Prostate Smart screening strategy for your 4Kscore.
1. Understand Your "Underlying" "True" Elevated or High PSA
PCA3 is often used in conjunction with PSA. Therefore, estimating your "Underlying" "True" PSA is the first step in risk assessment.
An elevated PSA (less than 5.0) or a high PSA (greater than 5.0) provide early warning of prostate activity for a smart prostate cancer screening strategy. (Links take you to one of our website pages that opens in a new window.)
Your "Underlying" "True" elevated PSA is the value that your physicians should use to assess your risk with the help of prostate cancer risk calculators or rules of thumb about threshold level of concern, such as 4.0 or 3.0 or an age-adjusted threshold level. Learn about risk calculators in the Blog post: Use prostate cancer risk calculators to avoid premature biopsy that opens in a new window.
Your "True" PSA is Hybritech calibrated and adjusted for specific medications to treat prostate enlargement (BPH). See the Blog post: Elevated PSA? Is your "True" PSA higher? that opens in a new window.
Your "Underlying" "True" PSA test level may be lower than your most recent "True" elevated PSA value because of temporary infection, inflammation or aggravation of your prostate. See the Blog post: Elevated PSA? Is your "Underlying" PSA lower? that opens in a new window.
Follow-up PSA testing is highly recommended for a long enough period for a possible infection to clear.
It is not known how PCA3 responds to temporary infection, inflammation or aggravation of your prostate. Therefore, it is unclear how much value there is in repeat PCA3 testing to determine an underlying value.
2. Why Does PCA3 Improve PSA Screening Effectiveness?
PSA screening for prostate cancer is limited in effectiveness because the PSA protein in the blood reflects all prostate conditions (an antigen specific to the prostate) rather than just prostate cancer (specific to prostate cancer).
PCA3 improves prostate cancer screening because the PCA3 gene present in urine is produced by prostate cancer in greater amounts than all other prostate conditions. In technical terms, PCA3 is a prostate specific gene that is overly expressed in prostate cancers. PCA3 Score is calculated as the ratio of the concentration of prostate cancer gene 3 (PCA3) RNA molecules to the concentration of prostate-specific antigen (PSA) RNA molecules multiplied by 1,000. The higher the PCA3 Score the more likely prostate cancer will be found by biopsy.
3. Interpret Your PCA3 Score and Prostate Volume
For any PSA level, the probability of cancer increases as the PCA3 Score increases.
What Is the Probability of Prostate Cancer for PCA3 Score?
A 2014 Journal of Clinical Oncology multi-center study addressed the question: Can Urinary PCA3 Supplement PSA in Early Detection of Prostate Cancer? (PubMed abstract will open in a new window). For screening prior to initial biopsy, the study reported results that allowed calculation of the probability of cancer detection by biopsy for four ranges of PCA3. We estimated the average of each range and estimated the probability of prostate cancer as a function of PCA3.
The graph on the right shows the estimated relationship between the probability of any prostate cancer and PCA3. In addition, it sets the stage for estimating and graphing the potential influence of prostate volume on the interpretation of PCA3, as shown in the next section.
We use the highly regarded ERSPC Risk Calculator, which estimates the probability of significant prostate cancer (high-grade and large low-grade) and the probability of any prostate cancer.
What Is the Probability of Significant Cancer for PHI and Prostate Volume?
We focus next on the implications of PCA3 and prostate volume for men with no other risk factors. For PSA 6.0, the graph on the right plots the estimated probability any prostate cancer will be found by biopsy as a function of PCA3 for three prostate volumes estimated by digital rectal exam (DRE): small (25cc), medium (40cc) and large (60cc). The estimated "what if" dashed curves are generated using the PCA3 graph above as a reference and matching ERSPC Risk Calculator results to it for a medium-size prostate (40cc) and 6.0 PSA by varying the analogous Prostate Health Index (PHI). This first step produces the dashed purple curve. Then the ERSPC-RC is rerun for the same variables for small (25cc) and large (60cc) prostates to produce the red and blue curves.
Notice that the probabilities are much higher for a small prostate (the top red line) than for a large prostate (the bottom blue line). The probability of cancer is lower for large prostates because they tend to produce more PSA that "explains" elevated levels of PSA.
The dramatic difference in risk for small and large prostates demonstrates why it is so important to consider prostate volume for elevated PSA levels. The risk level of 30% is the same at 8 PCA3 for a small prostate as at 26 PCA3 for a large prostate. Full interpretation of PCA3 should depend on prostate volume, even if done crudely.
Ask your physician to estimate your prostate volume by digital rectal exam (DRE). Ask for a transrectal ultrasound (TRUS) to measure your prostate volume more accurately before considering a biopsy. To learn more see our Ultrasound-Based Prostate Cancer Smart Screening Analysis page in a new window.
4. Analyze Your Elevated or High PSA Trend
In conjunction with PSA3, analysis of your PSA trend can provide valuable insights. See our Analyze Your Elevated or High PSA Trend and Free PSA % Trend page and our Elevated PSA? Is your "Underlying" PSA lower? Blog post in new windows.
5. Compare PCA3 to Other Enhanced Tests - Blood or Urine
Enhanced blood tests used with prostate cancer risk calculators can substantially improve prostate cancer screening effectiveness compared to PSA alone. We describe and compare six combinations of enhanced blood and urine tests and risk calculators. See our Compare PSA, Free PSA, PHI, 4Kscore, PCA3 page in a new window for our full comparison.
PCA3 is one of several enhanced test alternatives for prostate cancer screening.
Free PSA, PHI and 4Kscore blood tests are alternative enhanced tests that you can learn about in new windows.
Six Enhanced Test Combinations for Elevated and High PSA Test Levels (T1 to T6)
We consider six enhanced test combinations of blood and urine tests and risk calculators:
The one PCA3 enhanced test combination (T6) is described below:
T6. PCA3 Urine Test and Report
Hologic, Inc. provides the Progensa PCA3 genetic urine test.
Comparison of Enhanced Test Combinations for Elevated and High PSA Test Levels
We compare the six enhanced test combinations in five ways:
See our Compare PSA, Free PSA, PHI, 4Kscore, PCA3 page in a new window for our full comparison.
Cost and Reimbursement
Rough estimates of cost and reimbursement of the blood and urine tests:
We encourage you to plan ahead when considering cost and reimbursement. Ideally, you may choose an:
Moreover, your health insurance carrier may resist follow-up and periodic or annual enhanced tests, especially if the price is high.
Summary Comparison and Suggestions for Elevated or High PSA
There are three best enhanced test options with ranking based on what is important to you. Consideration of prostate volume (or not) is the biggest difference between PHI with ERSPC Risk Calculator using prostate volume and other alternatives.
If you are willing to operate the ERSPC Risk Calculator (and especially if either cost or consideration of prostate volume and TRUS ultrasound results are important to you) then consider:
If you are not willing to operate the ERSPC Risk Calculator and cost is not important to you then consider:
If you are not willing to operate the ERSPC Risk Calculator and cost is important to you then consider:
If you are concerned about operating the ERSPC Risk Calculator, we encourage you to enlist the help of a daughter, son, spouse or friend or even pay a student with computer skills.
Alternatively, we can operate the ERSPC Risk Calculator for you and create a full smart prostate cancer screening strategy report for you. Learn more about Prostate Smart Screening for Cancer at our home page in a new window.
6. Develop Your Prostate Smart Screening Strategy for Your 4Kscore
For men who want to lead a collaborative team effort rather than be a passive patient.
Prostate Smart analysis helps you create your strategy with your collaborative team of physicians and confidants to minimize your risks of:
> Regrettably late diagnosis of deadly cancer:
> Premature biopsy, diagnosis, treatment and side effects:
Analysis is needed to create the best personal screening strategy for you because:
We analyze published studies and present the implications for personal decisions. Studies are from: Mayo Clinic, Cleveland Clinic, Johns Hopkins, Memorial Sloan Kettering, NIH, NYU, UCLA, UC London, Yale and more.
Learn more about PSA-Based Prostate Smart Screening Strategy Analysis in a new window.
Return to Prostate Smart Screening for Cancer home page.